Evaluation of gabapentin and dexamethasone alone or in combination for pain control after adenotonsillectomy in children

Sabry Mohammad Amin, Sabry Mohammad Amin

Abstract

Background: Different methods and many drugs have been used to control the post-operative pain. In this study, we evaluate the role of gabapentin premedication and/or dexamethasone in management of post-operative pain following adenotonsillectomy in children.

Materials and methods: In a double-blind randomized study, 120 children were subjected for adenotonsillectomy classified into three equal groups. Group G: Gabapentin 10 mg/kg was given orally 2 h before induction of anesthesia (Gabapentin syrup 250 mg/5 ml. Group D: Children in this group received placebo pre-operatively and received dexamethasone 0.15 mg/kg intravenously after induction of anesthesia, but before surgery. Group C: Children in this group received combination of oral gabapentin 10 mg/kg 2 h before induction of anesthesia and intra-operative 0.15 mg/kg dexamethasone intravenously. All children underwent general anesthesia. Pain score was assisted post-operatively 2 h, 4 h, 6 h, 8 h, 12 h and 18 h after recovery using face, legs, activity, cry, consolability scale.

Results: Pain score in Group C and Group G was significantly less at 4 h, 6 h and 8 h post-operatively than in Group D (P < 0.05). At 12 h, the pain score in Group C was significantly less than Group G and Group D (P < 0.05). And no significant changes were observed in pain score at 18 h post-operatively between all groups (P > 0.05). The time to first analgesia was longer in the Group C than in Group G and Group D and the time to first analgesia was significantly longer in Group G than in Group D (P < 0.05). The total amount of pethidine was less in Group C and Group G than in Group D (P < 0.05). The incidence of post-operative nausea and vomiting was statically insignificant among all groups and no reported post-operative bleeding.

Conclusion: Gabapentin 10 mg/kg premedication combined with intra-operative dexamethasone 0.15 mg/kg prolongs the post-operative analgesia following adenotonsillectomy in children and decreases the amount of pethidine used post-operatively with no reported adverse effects or increase in the incidence of post-operative bleeding.

Keywords: Adenotonsillectomy; dexamethasone; gabapentin; post-operative pain; post-tonsillectomy bleeding.

Conflict of interest statement

Conflict of Interest: None

References

    1. Kamal SA, Basu S, Kapoor L, Kulandaivelu G, Talpalikar S, Papasthatis D. Harmonic scalpel tonsillectomy: A prospective study. Eur Arch Otorhinolaryngol. 2006;263:449–54.
    1. Page GG. The immune-suppressive effects of pain. Adv Exp Med Biol. 2003;521:117–25.
    1. Joshi GP, Ogunnaike BO. Consequences of inadequate post-operative pain relief and chronic persistent post-operative pain. Anesthesiol Clin North America. 2005;23:21–36.
    1. Michaloliakou C, Chung F, Sharma S. Preoperative multimodal analgesia facilitates recovery after ambulatory laparoscopic cholecystectomy. Anesth Analg. 1996;82:44–51.
    1. Kehlet H, Werner MU. Role of paracetamol in the acute pain management. Drugs. 2003;63:15.
    1. Schimmer BP, Parker KL. Goodman and Gilman's the Pharmacological Basis of Therapeutic. New York: McGraw Publishing; 1996. Adrenocoticotrophic hormone: Inhibitors of the synthesis and actions of adrenocortical hormons; p. 1459.
    1. Svensson CI, Yaksh TL. The spinal phospholipase-cyclooxygenase-prostanoid cascade in nociceptive processing. Annu Rev Pharmacol Toxicol. 2002;42:553–83.
    1. Kong VK, Irwin MG. Gabapentin: A multimodal perioperative drug? Br J Anaesth. 2007;99:775–86.
    1. Haig GM, Bockbrader HN, Wesche DL, Boellner SW, Ouellet D, Brown RR, et al. Single-dose gabapentin pharmacokinetics and safety in healthy infants and children. J Clin Pharmacol. 2001;41:507–14.
    1. Koç S, Memis D, Sut N. The preoperative use of gabapentin, dexamethasone, and their combination in varicocele surgery: A randomized controlled trial. Anesth Analg. 2007;105:1137–42.
    1. Rasmussen ML, Mathiesen O, Dierking G, Christensen BV, Hilsted KL, Larsen TK, et al. Multimodal analgesia with gabapentin, ketamine and dexamethasone in combination with paracetamol and ketorolac after hip arthroplasty: A preliminary study. Eur J Anaesthesiol. 2010;27:324–30.
    1. Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S. The FLACC: A behavioral scale for scoring post-operative pain in young children. Pediatr Nurs. 1997;23:293–7.
    1. Davies A, Hendrich J, Van Minh AT, Wratten J, Douglas L, Dolphin AC. Functional biology of the alpha(2)delta subunits of voltage-gated calcium channels. Trends Pharmacol Sci. 2007;28:220–8.
    1. Luo ZD, Calcutt NA, Higuera ES, Valder CR, Song YH, Svensson CI, et al. Injury type-specific calcium channel alpha 2 delta-1 subunit up-regulation in rat neuropathic pain models correlates with antiallodynic effects of gabapentin. J Pharmacol Exp Ther. 2002;303:1199–205.
    1. Mikkelsen S, Hilsted KL, Andersen PJ, Hjortsø NC, Enggaard TP, Jørgensen DG, et al. The effect of gabapentin on post-operative pain following tonsillectomy in adults. Acta Anaesthesiol Scand. 2006;50:809–15.
    1. Jeon EJ, Park YS, Park SS, Lee SK, Kim DH. The effectiveness of gabapentin on post-tonsillectomy pain control. Eur Arch Otorhinolaryngol. 2009;266:1605–9.
    1. Dirks J, Fredensborg BB, Christensen D, Fomsgaard JS, Flyger H, Dahl JB. A randomized study of the effects of single-dose gabapentin versus placebo on post-operative pain and morphine consumption after mastectomy. Anesthesiology. 2002;97:560–4.
    1. Fassoulaki A, Patris K, Sarantopoulos C, Hogan Q. The analgesic effect of gabapentin and mexiletine after breast surgery for cancer. Anesth Analg. 2002;95:985–91.
    1. Turan A, Memiş D, Karamanlioğlu B, Yağiz R, Pamukçu Z, Yavuz E. The analgesic effects of gabapentin in monitored anesthesia care for ear-nose-throat surgery. Anesth Analg. 2004;99:375–8.
    1. Gilron I, Orr E, Tu D, O’Neill JP, Zamora JE, Bell AC. A placebo-controlled randomized clinical trial of perioperative administration of gabapentin, rofecoxib and their combination for spontaneous and movement-evoked pain after abdominal hysterectomy. Pain. 2005;113:191–200.
    1. Mohammadi SS, Seyedi M. Comparing oral gabapentin versus clonidine as premedication on early post-operative pain, nausea and vomiting following general anesthesia. Saudi J Anaesth. 2009;3:25.
    1. Kaan MN, Odabasi O, Gezer E, Daldal A. The effect of preoperative dexamethasone on early oral intake, vomiting and pain after tonsillectomy. Int J Pediatr Otorhinolaryngol. 2006;70:73–9.
    1. Steward DL, Welge JA, Myer CM. Do steroids reduce morbidity of tonsillectomy? Meta-analysis of randomized trials. Laryngoscope. 2001;111:1712–8.
    1. Windfuhr JP. Steroids for reduction of morbidity following tonsillectomy. HNO. 2008;56:43–53.
    1. Al-Shehri AM. Steroid therapy for post-tonsillectomy symptoms in adults: A randomized, placebo-controlled study. Ann Saudi Med. 2004;24:365–7.
    1. Carr AS, Courtman S, Holtby H, Morton N, Jacobson S, Brennan L, et al. Guidelines on the Prevention of Postoperative Vomiting in Children. Association of Paediatric Anaesthetists of Great Britain and Ireland; spring. 2009. [Last accessed date on 2014 Jan 07]. p. 20. .
    1. Brigger MT, Cunningham MJ, Hartnick CJ. Dexamethasone administration and postoperative bleeding risk in children undergoing tonsillectomy. Arch Otolaryngol Head Neck Surg. 2010;136:766–72.
    1. Geva A, Brigger MT. Dexamethasone and tonsillectomy bleeding: A meta-analysis. Otolaryngol Head Neck Surg. 2011;144:838–43.
    1. Shakeel M, Trinidade A, Al-Adhami A, Karamchandani D, Engelhardt T, Ah-See KW, et al. Intraoperative dexamethasone and the risk of secondary posttonsillectomy hemorrhage. J Otolaryngol Head Neck Surg. 2010;39:732–6.
    1. Windfuhr JP, Chen YS, Propst EJ, Güldner C. The effect of dexamethasone on post-tonsillectomy nausea, vomiting and bleeding. Braz J Otorhinolaryngol. 2011;77:373–9.
    1. Czarnetzki C, Elia N, Lysakowski C, Dumont L, Landis BN, Giger R, et al. Dexamethasone and risk of nausea and vomiting and postoperative bleeding after tonsillectomy in children: A randomized trial. JAMA. 2008;300:2621–30.
    1. Panarese A, Clarke RW, Yardley MP. Early post-operative morbidity following tonsillectomy in children: Implications for day surgery. J Laryngol Otol. 1999;113:1089–91.

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