Comparative evaluation of oral gabapentin versus clonidine as premedication on preoperative sedation and laryngoscopic stress response attenuation for the patients undergoing general anesthesia

Effectiveness of oral clonidine and gabapentin on peripheral neuropathy in diabetic patients in southwestern Iran: a randomized clinical trial

BACKGROUND

Peripheral neuropathy is not only the most prevalent consequence of diabetes but also the main reason for foot ulceration, disability, and amputation. Therefore, the current study aims to determine the effectiveness of oral clonidine and gabapentin on peripheral neuropathy in diabetic patients.

METHODS

This 12-week, randomized, and parallel-group trial was conducted to compare the efficacy of oral clonidine and gabapentin with gabapentin alone in diabetic patients in southwest Iran during the first half of 2021. Thirty patients with type 2 diabetes with peripheral neuropathy as assessed by a visual analog scale (VAS) and divided into two groups of 15 patients, treated for up to three months. The data were analyzed using SPSS-21 software. In order to report the results, descriptive indices, independent t-test, one-way analysis of covariance (ANCOVA) and analysis of variance with repeated measures were used.

RESULTS

The mean and standard deviation of the age of the participants in the clonidine + gabapentin group was equal to 50.20 ± 7.44, and in the gabapentin group was equal to 50.47 ± 7.57 (t = 0.10, P-value = 0.923). This research showed a significant difference between the clonidine + gabapentin group and with gabapentin group in terms of neuropathic pain and the severity of neuropathic pain (P < 0.001).

CONCLUSIONS

According to this research results, clonidine + gabapentin can reduce neuropathic pain and the severity of neuropathic pain in diabetic patients. Therefore, it is recommended that healthcare professionals with diabetes expertise prescribe these medications to reduce neuropathic pain and its severity.

TRIAL REGISTRATION

This study was registered in the Iranian Clinical Trials System with the ID (IRCT20211106052983N1) on 14/01/2022.

A Comparison Between the Effects of Single-Dose Oral Gabapentin and Oral Clonidine on Hemodynamic Parameters in Laparoscopic Surgeries: A Randomized Controlled Trial

Background and objective Laparoscopic surgeries can result in exaggerated sympathetic responses due to pneumoperitoneum. Many drugs including clonidine and gabapentin have been evaluated to attenuate the hemodynamic response to abdominal insufflation. In light of this, this study was conducted to compare the effects of preoperative administration of oral gabapentin with those of clonidine on intraoperative hemodynamic parameters in patients undergoing laparoscopic surgeries. Methodology A prospective, randomized, double-blinded comparative trial spanning a period of one year was conducted involving 150 patients scheduled to undergo elective laparoscopic surgeries at a tertiary hospital. Patients who fulfilled the inclusion criteria were randomly allocated into three groups: to receive oral gabapentin 300 mg (Group G) or oral clonidine 150 mcg (Group CL) or a placebo tablet (Group C). Standard anesthetic protocols were followed during the surgery and the mean arterial pressure (MAP), heart rate (HR), postoperative pain as assessed by visual analog scale (VAS) scores, postoperative analgesic consumption, sedation scores, and complications like nausea, vomiting, and dry mouth were recorded and analyzed. Results HR and MAP were significantly reduced in the intervention groups (clonidine and gabapentin) compared to the control group. There was a statistically significant reduction in MAP and HR in patients on oral clonidine compared to patients on gabapentin. Postoperative pain as assessed by VAS score was better in the intervention groups compared to patients who were administered a placebo. Postoperative analgesic consumption was significantly lower in patients on clonidine and gabapentin compared to the control group. Patients on oral gabapentin received lower doses of tramadol compared to patients on clonidine. Postoperative sedation as assessed by the Ramsay sedation scale (RSS) score was higher in patients on oral gabapentin. Complications like postoperative nausea and vomiting were significantly reduced in the intervention groups, while dryness of mouth was more prevalent in patients on clonidine. Conclusion Based on our findings, oral clonidine is more effective in attenuating hemodynamic response to pneumoperitoneum compared to oral gabapentin. Postoperative pain was lower in intervention groups compared to the control group. However, patients on gabapentin required a lower dose of analgesics postoperatively compared to patients on clonidine. Postoperative sedation was also more pronounced in patients on gabapentin while dryness of mouth was more common in patients on oral clonidine.

Effectiveness of preanesthetic administration of gabapentin on sedative action during intravenous sedation with propofol

PURPOSE

There are no sufficient evidences for the sedative effect of gabapentin during anesthesia, especially intravenous sedation (IVS). The purpose of this study was to evaluate the sedative effect of gabapentin as preanesthetic medication during the IVS with propofol.

METHODS

10 volunteer subjects joined this study. They underwent propofol IVS three times on separate days. On the first day, the IVS without gabapentin was performed as a control. On the second and the third day, gabapentin 200 mg and 400 mg were administered before the IVS, respectively. The target blood concentration (C_T) of propofol was gradually increased, and the bispectral index (BIS) value and Ramsay sedation score (RSS) were evaluated at each propofol C_T. Postanesthetic complications and influences on vital signs were also evaluated.

RESULTS

Compared to the control group, the propofol C_Ts in the gabapentin 400 mg group significantly reduced at the BIS values of 60 and 70 (p = 0.031 and p = 0.043, respectively), and at RSS 3, 4, 5 and 6 (p = 0.040, p = 0.004, p = 0.001 and p = 0.004, respectively). There was no significant difference in propofol C_Ts between the control group and the gabapentin 200 mg group. There were no abnormality and no deterioration in circulation and respiration in all groups. There were no significant increases in complications with the administration of gabapentin.

CONCLUSION

The oral administration of 400 mg dose of gabapentin reduced the propofol C_Ts for achieving an adequate sedation level on IVS.