Departments of Anesthesiology and Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, Kerala, India.
J Neurosurg Anesthesiol. 2013 Oct;25(4):386-91. doi: 10.1097/ANA.0b013e31829327eb.
In patients undergoing craniotomy, the incidence of postoperative nausea and vomiting (PONV) is 55% to 70% and that of moderate to severe postoperative pain is 60% to 84%. We hypothesized that gabapentin plus dexamethasone would be superior, compared with placebo and dexamethasone in reducing the incidences of PONV and pain after craniotomy.
Patients undergoing craniotomy received either placebo (group D) or gabapentin (600 mg) (group GD) premedication orally, 2 hours before induction of anesthesia. In addition, all patients received 4 mg of intravenous dexamethasone on the morning of surgery and continued receiving it after every 8 hours. The 24-hour incidence of nausea, emesis, or PONV (nausea, emesis, or both) (primary outcome) and postoperative pain scores (secondary outcome) were analyzed with the χ test and the Wilcoxon rank-sum test as applicable.
A significant difference was observed between the groups in the incidence of nausea (odds ratio [OR], 0.23; 95% confidence interval [CI], 0.07, 0.80; P=0.02), PONV (OR, 0.3; 95% CI, 0.08, 0.8; P=0.02), and the requirement for antiemetics (OR, 0.30; 95% CI, 0.09, 0.9; P=0.03). The number of emetic episodes were also reduced in group GD, but this did not assume statistical significance (OR, 0.34; 95% CI, 0.10, 1.1; P=0.06). However, there was no significant difference in either the postoperative pain scores or the opioid consumption between the 2 groups.
A dosage of 600 mg of gabapentin plus 4 mg of dexamethasone significantly reduced the 24-hour incidence of nausea and PONV. However, there was no reduction in either the postoperative pain scores or opioid consumption.
在接受开颅手术的患者中，术后恶心和呕吐（PONV）的发生率为 55%至 70%，中度至重度术后疼痛的发生率为 60%至 84%。我们假设与安慰剂和地塞米松相比，加巴喷丁联合地塞米松可降低开颅术后 PONV 和疼痛的发生率。
接受开颅手术的患者在麻醉诱导前 2 小时口服安慰剂（D 组）或加巴喷丁（600mg）（GD 组）。此外，所有患者在手术当天早上接受 4mg 静脉地塞米松，并在每 8 小时后继续接受。使用 χ 检验和 Wilcoxon 秩和检验分析 24 小时恶心、呕吐或 PONV（恶心、呕吐或两者均有）（主要结局）和术后疼痛评分（次要结局）。
两组在恶心发生率（优势比[OR]，0.23；95%置信区间[CI]，0.07，0.80；P=0.02）、PONV 发生率（OR，0.3；95%CI，0.08，0.8；P=0.02）和止吐药需求（OR，0.30；95%CI，0.09，0.9；P=0.03）方面存在显著差异。GD 组的呕吐发作次数也有所减少，但无统计学意义（OR，0.34；95%CI，0.10，1.1；P=0.06）。然而，两组的术后疼痛评分或阿片类药物消耗无显著差异。
加巴喷丁 600mg 联合地塞米松 4mg 可显著降低 24 小时恶心和 PONV 的发生率。然而，术后疼痛评分或阿片类药物消耗均无降低。
