Gabapentin in acute postoperative pain management

Connie Y Chang, Chaitanya K Challa, Janki Shah, Jean Daniel Eloy, Connie Y Chang, Chaitanya K Challa, Janki Shah, Jean Daniel Eloy

Abstract

Gabapentin (1-aminomethyl-cyclohexaneacetic acid) is an amino acid that has the structure of the neurotransmitter γ -aminobutyric acid (GABA). It is a novel drug used for the treatment of postoperative pain with antihyperalgesic properties and a unique mechanism of action. Gabapentin and the related, more potent compound pregabalin have been shown to be beneficial in the treatment of neuropathic pain as well as postoperative pain following spinal surgery and hysterectomy. This study reviews five aspects of gabapentin: (1) chemical and structural characteristics; (2) pharmacokinetics and pharmacodynamics; (3) application in acute pain management; (4) adverse effects; and (5) drug safety. Overall, gabapentin has been reported to be a safe and efficacious drug for the treatment of postoperative pain.

References

    1. Maneuf YP, Gonzalez MI, Sutton KS, Chung FZ, Pinnock RD, Lee K. Cellular and molecular action of the putative GABA-mimetic, gabapentin. Cellular and Molecular Life Sciences. 2003;60(4):742–750.
    1. Gidal B, Billington R. New and emerging treatment options for neuropathic pain. The American Journal of Managed Care. 2006;12:S269–S278.
    1. Taylor CP, Gee NS, Su TZ, et al. A summary of mechanistic hypotheses of gabapentin pharmacology. Epilepsy Research. 1998;29(3):233–249.
    1. Dahl JB, Mathiesen O, Møiniche S. ‘Protective premedication’: an option with gabapentin and related drugs? A review of gabapentin and pregabalin in the treatment of post-operative pain. Acta Anaesthesiologica Scandinavica. 2004;48(9):1130–1136.
    1. Sills GJ. Not another gabapentin mechanism! Epilepsy Currents. 2005;5(2):75–77.
    1. Elwes RDC, Binnie CD. Clinical pharmacokinetics of newer antiepileptic drugs. Lamotrigine, vigabatrin, gabapentin and oxcarbazepine. Clinical Pharmacokinetics. 1996;30(6):403–415.
    1. Markman JD, Dworkin RH. Ion channel targets and treatment efficacy in neuropathic pain. Journal of Pain. 2006;7:S38–S47.
    1. Segal AZ, Rordorf G. Gabapentin as a novel treatment for postherpetic neuralgia. Neurology. 1996;46(4):1175–1176.
    1. Rosner H, Rubin L, Kestenbaum A. Gabapentin adjunctive therapy in neuropathic pain states. Clinical Journal of Pain. 1996;12(1):56–58.
    1. Zapp JJ. Postpoliomyelitis pain treated with gabapentin. The American Family Physician. 1996;53:2442–2445.
    1. Mellick GA, Mellick LB. Reflex sympathetic dystrophy treated with gabapentin. Archives of Physical Medicine and Rehabilitation. 1997;78(1):98–105.
    1. Backonja M, Beydoun A, Edwards KR, et al. Gabapentin for the symptomatic treatment of painful neuropathy in patients with diabetes mellitus. A randomized controlled trial. Journal of the American Medical Association. 1998;280(21):1831–1836.
    1. Ho KY, Gan TJ, Habib AS. Gabapentin and postoperative pain—a systematic review of randomized controlled trials. Pain. 2006;126(1-3):91–101.
    1. Bartoszyk GD, Meyerson N, Reimann W, Satzinger G, von Hodenberg A. Gabapentin. In: Meldrum BS, Porter BJ, editors. New Anticonvulsant Drugs. London, UK: John Libbey; 1986. pp. 147–163.
    1. Hooper WD, Kavanagh MC, Dickinson RG. Determination of gabapentin in plasma and urine by capillary column gas chromatography. Journal of Chromatography. 1990;529(1):167–174.
    1. Hengy H, Kolle EU. Determination of gabapentin in plasma and urine by high-performance liquid chromatography and pre-column labelling for ultraviolet detection. Journal of Chromatography. 1985;341(2):473–478.
    1. Sagirli O, Çetin SM, Önal A. Determination of gabapentin in human plasma and urine by high-performance liquid chromatography with UV-vis detection. Journal of Pharmaceutical and Biomedical Analysis. 2006;42(5):618–624.
    1. Rose MA, Kam PCA. Gabapentin: pharmacology and its use in pain management. Anaesthesia. 2002;57(5):451–462.
    1. Hill DR, Suman-Chauhan N, Woodruff GN. Localization of [3H]gabapentin to a novel site in rat brain: autoradiographic studies. European Journal of Pharmacology. 1993;244(3):303–309.
    1. Welty DF, Schielke GP, Vartanian MG, Taylor CP. Gabapentin anticonvulsant action in rats: Disequilibrium with peak drug concentrations in plasma and brain microdialysate. Epilepsy Research. 1993;16(3):175–181.
    1. Partridge BJ, Chaplan SR, Sakamoto E, Yaksh TL. Characterization of the effects of gabapentin and 3-isobutyl-γ- aminobutyric acid on substance P-induced thermal hyperalgesia. Anesthesiology. 1998;88(1):196–205.
    1. Malmberg AB, Yaksh TL. Voltage-sensitive calcium channels in spinal nociceptive processing: blockade of N- and P-type channels inhibits formalin-induced nociception. Journal of Neuroscience. 1994;14(8):4882–4890.
    1. Fink K, Meder W, Dooley DJ, Göthert M. Inhibition of neuronal Ca2+ influx by gabapentin and subsequent reduction of neurotransmitter release from rat neocortical slices. British Journal of Pharmacology. 2000;130(4):900–906.
    1. Dooley DJ, Mieske CA, Borosky SA. Inhibition of K+-evoked glutamate release from rat neocortical and hippocampal slices by gabapentin. Neuroscience Letters. 2000;280(2):107–110.
    1. Reimann W. Inhibition by GABA, baclofen and gabapentin of dopamine release from rabbit caudate nucleus: are there common or different sites of action? European Journal of Pharmacology. 1983;94(3-4):341–344.
    1. Schlicker E, Reimann W, Gothert M. Gabapentin decreases monoamine release without affecting acetylcholine release in the brain. Arzneimittel-Forschung/Drug Research. 1985;35(9):1347–1349.
    1. Wamil AW, McLean MJ. Limitation by gabapentin of high frequency action potential firing by mouse central neurons in cell culture. Epilepsy Research. 1994;17(1):1–11.
    1. Stewart BH, Kugler AR, Thompson PR, Bockbrader HN. A saturable transport mechanism in the intestinal absorption of gabapentin is the underlying cause of the lack of proportionality between increasing dose and drug levels in plasma. Pharmaceutical Research. 1993;10(2):276–281.
    1. McLean MJ. Clinical pharmacokinetics of gabapentin. Neurology. 1994;44:S17–S22.
    1. Vollmer KO, Anhut H, Thomann P, Wagner F, Jahncken D. Pharmacokinetic model and absolute bioavailability of the new anticonvulsant gabapentin. Advances in Epileptology. 1989;17:209–211.
    1. Turck VK D, Bockbrader H, Sedman A. Dose-linearity of the new anticonvulsant gabapentin after multiple oral doses. European Journal of Clinical Pharmacology. 1989;36(supplement A310):8–11.
    1. Baldwin TO, Ziegler MM, Chaffotte AF, Goldberg ME. Contribution of folding steps involving the individual subunits of bacterial luciferase to the assembly of the active heterodimeric enzyme. Journal of Biological Chemistry. 1993;268(15):10766–10772.
    1. Goa KL, Sorkin EM. Gabapentin: a review of its pharmacological properties and clinical potential in epilepsy. Drugs. 1993;46(3):409–427.
    1. Beydoun A, Uthman BM, Sackellares JC. Gabapentin: Pharmacokinetics, efficacy, and safety. Clinical Neuropharmacology. 1995;18(6):469–481.
    1. Ben-Menachem E, Persson LI, Hedner T. Selected CSF biochemistry and gabapentin concentrations in the CSF and plasma in patients with partial seizures after a single oral dose of gabapentin. Epilepsy Research. 1992;11(1):45–49.
    1. Ojemann LM, Friel PN, Ojemann GA. Gabapentin concentrations in human brain. Epilepsia. 1988;29:p. 694.
    1. Vollmer K-O, Von Hodenberg A, Kolle EU. Pharmacokinetics and metabolism of gabapentin in rat, dog and man. Arzneimittel-Forschung. 1986;36(5):830–839.
    1. Blum RA, Comstock TJ, Sica DA, et al. Pharmacokinetics of gabapentin in subjects with various degrees of renal function. Clinical Pharmacology and Therapeutics. 1994;56(2):154–159.
    1. Wong MO, Eldon MA, Keane WF, et al. Disposition of gabapentin in anuric subjects on hemodialysis. Journal of Clinical Pharmacology. 1995;35(6):622–626.
    1. Busch RL JA, Radulovic L, Bockbrader HN, Underwood BA, Sedman AJ, Chang T. Effect of Maalox TC on single- dose pharmacokinetics of gabapentin capsules in healthy subjects. Pharmaceutical Research. 1992;9(supplement):p. S315.
    1. Ucak A, Onan B, Sen H, Selcuk I, Turan A, Yilmaz AT. The effects of gabapentin on acute and chronic postoperative pain after coronary artery bypass graft surgery. Journal of Cardiothoracic and Vascular Anesthesia. 2011;25(5):824–829.
    1. Zakkar M, Frazer S, Hunt I. Is there a role for Gabapentin in preventing or treating pain following thoracic surgery? Interactive Cardiovascular and Thoracic Surgery. 2013;17:716–719.
    1. Huot MP, Chouinard P, Girard F, Ruel M, Lafontaine ER, Ferraro P. Gabapentin does not reduce post-thoracotomy shoulder pain: a randomized, double-blind placebo-controlled study. Canadian Journal of Anesthesia. 2008;55(6):337–343.
    1. Kinney MAO, Mantilla CB, Carns PE, et al. Preoperative gabapentin for acute post-thoracotomy analgesia: a randomized, double-blinded, active placebo-controlled study. Pain Practice. 2012;12(3):175–183.
    1. Sihoe AD, Lee TW, Wan IYP, Thung KH, Yim AP. The use of gabapentin for post-operative and post-traumatic pain in thoracic surgery patients. European Journal of Cardio-thoracic Surgery. 2006;29(5):795–799.
    1. Solak O, Metin M, Esme H, et al. Effectiveness of gabapentin in the treatment of chronic post-thoracotomy pain. European Journal of Cardio-thoracic Surgery. 2007;32(1):9–12.
    1. Lee JH, Lee HK, Chun NH, So Y, Lim CY. The prophylactic effects of gabapentin on postoperative sore throat after thyroid surgery. Korean Journal of Anesthesiology. 2013;64:138–142.
    1. Misra S, Parthasarathi G, Vilanilam GC. The effect of gabapentin premedication on postoperative nausea, vomiting, and pain in patients on preoperative dexamethasone undergoing craniotomy for intracranial tumors. Journal of Neurosurgical Anesthesiology. 2013;25:386–391.
    1. Yu L, Ran B, Li M, Shi Z. Gabapentin and pregabalin in the management of postoperative pain after lumbar spinal surgery: a systematic review and meta-analysis. Spine. 2013;38(22):1947–1952.
    1. Ajori L, Nazari L, Mazloomfard MM, Amiri Z. Effects of gabapentin on postoperative pain, nausea and vomiting after abdominal hysterectomy: a double blind randomized clinical trial. Archives of Gynecology and Obstetrics. 2012;285:677–682.
    1. Siddiqui NT, Fischer H, Guerina L, Friedman Z. Effect of a preoperative gabapentin on postoperative analgesia in patients with inflammatory bowel disease following major bowel surgery: a randomized, placebo-controlled trial. Pain Practice. 2013;14(2):132–139.
    1. Panah Khahi M, Yaghooti AA, Marashi SH, Nadjafi A. Effect of pre-emptive gabapentin on postoperative pain following lower extremity orthopaedic surgery under spinal anaesthesia. Singapore Medical Journal. 2011;52(12):879–882.
    1. McLean MJ, Morrell MJ, Willmore LJ, et al. Safety and tolerability of gabapentin as adjunctive therapy in a large, multicenter study. Epilepsia. 1999;40(7):965–972.
    1. Beal B, Moeller-Bertram T, Schilling JM, Wallace MS. Gabapentin for once-daily treatment of post-herpetic neuralgia: a review. Clinical Interventions in Aging. 2012;7:249–255.
    1. Clivatti J, Sakata RK, Issy AM. Review of the use of gabapentin in the control of postoperative pain. Revista Brasileira de Anestesiologia. 2009;59(1):87–98.
    1. Turan A, Karamanlioğlu B, Memiş D, et al. Analgesic Effects of Gabapentin after Spinal Surgery. Anesthesiology. 2004;100(4):935–938.
    1. Sen H, Sizlan A, Yanarates O, et al. A comparison of gabapentin and ketamine in acute and chronic pain after hysterectomy. Anesthesia and Analgesia. 2009;109(5):1645–1650.
    1. Gilron I, Bailey JM, Tu D, Holden RR, Jackson AC, Houlden RL. Nortriptyline and gabapentin, alone and in combination for neuropathic pain: a double-blind, randomised controlled crossover trial. The Lancet. 2009;374(9697):1252–1261.
    1. Compton P, Kehoe P, Sinha K, Torrington MA, Ling W. Gabapentin improves cold-pressor pain responses in methadone-maintained patients. Drug and Alcohol Dependence. 2010;109(1–3):213–219.
    1. Norton JW. Gabapentin withdrawal syndrome. Clinical Neuropharmacology. 2001;24(4):245–246.
    1. Barrueto F, Jr., Green J, Howland MA, Hoffman RS, Nelson LS. Gabapentin withdrawal presenting as status epilepticus. Journal of Toxicology. 2002;40(7):925–928.
    1. Tran KT, Hranicky D, Lark T, Jacob NJ. Gabapentin withdrawal syndrome in the presence of a taper. Bipolar Disorders. 2005;7(3):302–304.
    1. Rowbotham M, Harden N, Stacey B, Bernstein P, Magnus-Miller L. Gabapentin for the treatment of postherpetic neuralgia: a randomized controlled trial. Journal of the American Medical Association. 1998;280(21):1837–1842.
    1. Mao J, Chen LL. Gabapentin in pain management. Anesthesia and Analgesia. 2000;91(3):680–687.

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