Prabhakar Hemanshu, Arora Rajni, Bithal Parmod K, Rath Girija P, Dash Hari H
Department of Neuroanaesthesiology, All India Institute of Medical Sciences, New Delhi, India-110029.
J Neurosurg Anesthesiol. 2007 Oct;19(4):235-8. doi: 10.1097/ANA.0b013e3181271863.
There are reports indicating that gabapentin may have place in the treatment of postoperative pain. No study has evaluated the effects of gabapentin on acute, postoperative pain in patients undergoing surgery for brachial plexus injuries. In this preliminary study, we evaluated gabapentin as preemptive analgesic for intraoperative period and during the acute postoperative period at rest and during movement. Twenty consecutive adult patients undergoing surgery for brachial plexus injury were enrolled for the study. Patients randomly received either oral gabapentin 800 mg or placebo capsules 2 hours before surgery. General anesthesia was induced and maintained with propofol, at bispectral index value between 40 and 60. Intraoperative fentanyl and propofol requirements were noted. Postoperatively, all patients were alert and pain was assessed using visual analog scale (VAS) for 24 hours, both during rest and movement. Whenever VAS score was more than 50 or on patients' demand, ketorolac 30 mg was given as rescue analgesic. The demographics, duration of surgery, and propofol consumption in both groups were comparable. Intraoperative and postoperative heart rate and mean blood pressure were also comparable. Significant difference was noted in intraoperative fentanyl consumption (P=0.03), total dose of rescue analgesic (P=0.004), and VAS score at rest and movement, between the 2 groups; less in gabapentin group as compared with placebo group (P=0.01 and 0.04, at rest and movement, respectively). A single oral dose of gabapentin 800 mg, as preemptive analgesic in patients undergoing surgery for brachial plexus injury is found to be an effective adjunct to intraoperative and postoperative pain. Pain is reduced not only at rest but also during movement.
有报告表明加巴喷丁在术后疼痛治疗中可能占有一席之地。尚无研究评估加巴喷丁对接受臂丛神经损伤手术患者的急性术后疼痛的影响。在这项初步研究中，我们评估了加巴喷丁作为术中及术后急性期休息和活动时的超前镇痛药物的效果。连续20例接受臂丛神经损伤手术的成年患者纳入本研究。患者在手术前2小时随机接受口服800毫克加巴喷丁或安慰剂胶囊。采用丙泊酚诱导并维持全身麻醉，脑电双频指数值维持在40至60之间。记录术中芬太尼和丙泊酚的用量。术后，所有患者均保持清醒，并在休息和活动时使用视觉模拟评分法（VAS）评估疼痛24小时。每当VAS评分超过50或患者有需求时，给予30毫克酮咯酸作为解救镇痛药。两组患者的人口统计学资料、手术时间和丙泊酚用量具有可比性。术中及术后的心率和平均血压也具有可比性。两组在术中芬太尼用量（P = 0.03）、解救镇痛药总剂量（P = 0.004）以及休息和活动时的VAS评分方面存在显著差异；加巴喷丁组低于安慰剂组（休息和活动时分别为P = 0.01和0.04）。发现单次口服800毫克加巴喷丁作为臂丛神经损伤手术患者的超前镇痛药，是术中及术后疼痛的有效辅助药物。不仅在休息时疼痛减轻，而且在活动时疼痛也减轻。
