Dhakal Laxmi P, Hodge David O, Nagel Jay, Mayes Michael, Richie Alexa, Ng Lauren K, Freeman William D
Department of Critical Care, Mayo Clinic, Jacksonville, FL, USA.
Neurocrit Care. 2015 Jun;22(3):414-21. doi: 10.1007/s12028-014-0086-5.
Headache after aneurysmal subarachnoid hemorrhage (SAH) is very common and is often described as the "worst headache imaginable." SAH-associated headache can persist for days to weeks and is traditionally treated with narcotics. However, narcotics can have significant adverse effects. We hypothesize that gabapentin (GBP), a non-narcotic neuropathic pain medication, would be safe and tolerable and would reduce narcotic requirements after SAH.
We retrospectively reviewed the clinical, radiographic, and laboratory data of SAH patients at the neuroscience intensive care unit at Mayo Clinic in Jacksonville, Florida, from January 2011 through February 2013. Headache intensity was quantified by a visual analog scale score. Total opioid use per day was tabulated using an intravenous morphine equivalents scale. Cerebrospinal fluid was also reviewed when available.
There were 53 SAH patients who were treated with GBP along with other analgesics for headache. Among these SAH patients, 34 (64 %) were women, with a mean age of 54 years (SD 12.3). Severe headache was observed in all SAH patients. GBP dosing was rapidly escalated within days of SAH up to a median of 1,200 mg/day, with a range of 300 mg three times a day to 900 mg three times a day. Approximately 6 % of patients treated with GBP had nausea (95 % CI 1-16 %), and only one patient (1.8 %) had to discontinue GBP.
GBP appears to be relatively safe and tolerable in SAH patients with headache and may be a useful narcotic-sparing agent to prevent narcotics-associated complications, such as gastrointestinal immobility, ileus, and constipation.
动脉瘤性蛛网膜下腔出血（SAH）后头痛非常常见，常被描述为“难以想象的最严重头痛”。SAH相关头痛可持续数天至数周，传统上用麻醉药治疗。然而，麻醉药可能有显著的不良反应。我们假设加巴喷丁（GBP），一种非麻醉性神经性疼痛药物，对SAH患者是安全且可耐受的，并能减少SAH后的麻醉药需求。
我们回顾性分析了2011年1月至2013年2月在佛罗里达州杰克逊维尔市梅奥诊所神经科学重症监护病房的SAH患者的临床、影像学和实验室数据。头痛强度通过视觉模拟量表评分进行量化。每天使用静脉注射吗啡等效量表统计阿片类药物的总用量。如有脑脊液也进行分析。
53例SAH患者接受了GBP联合其他镇痛药治疗头痛。在这些SAH患者中，34例（64%）为女性，平均年龄54岁（标准差12.3）。所有SAH患者均观察到严重头痛。GBP剂量在SAH后数天内迅速增加至中位数1200毫克/天，范围为每日三次，每次300毫克至每日三次，每次900毫克。接受GBP治疗的患者中约6%有恶心（95%可信区间1 - 16%），只有1例患者（1.8%）不得不停用GBP。
GBP在SAH头痛患者中似乎相对安全且可耐受，可能是一种有用的减少麻醉药用量的药物，可预防与麻醉药相关的并发症，如胃肠道蠕动减慢、肠梗阻和便秘。
