Preoperative Gabapentin to Prevent Postoperative Shoulder Pain After Laparoscopic Ovarian Cystectomy: A Randomized Clinical Trial

Mehrnaz Valadan, Sakineh Banifatemi, Fardin Yousefshahi, Mehrnaz Valadan, Sakineh Banifatemi, Fardin Yousefshahi

Abstract

Background: Patients undergoing gynecology laparoscopy frequently experience shoulder pain as a common postoperative complication. Considering diaphragm stimulation in its pathophysiology, there are some advice to prevent or control this special form of referral pain.

Objectives: The current study aimed to assess the prophylactic effect of preoperative administration of oral gabapentin to prevent Post Laparoscopic Shoulder Pain (PLSP) after laparoscopic ovarian cystectomy.

Patients and methods: In a randomized, double blind, placebo controlled trial 40 female patients who were candidates to have elective laparoscopic ovarian cystectomy, received uniformed capsules containing gabapentin 600 mg or placebo 30 minutes before anesthesia induction. All patients had the American Society of Anesthesiologists (ASA) Physical Status of I-II and none had pervious abdominal surgery. Thereafter, the presence of side effects and PLSP and its severity was assessed by Visual Analog Scale (VAS) in the beginning of surgery and 2, 6, 12 hours after the surgery.

Results: Comparing the gabapentin (n = 20) and placebo (n = 20) groups, basic characteristics including age (P = 0.446), Body Mass Index (BMI) (P = 0.876), pregnancy history (P = 0.660), and surgery time (P = 0.232) were statistically similar. PLSP occurrence was less frequent in the gabapentin group (45%) compared with the placebo group (75%) (P = 0.053), while In gabapentin group the VAS scores were lower in 2(P = 0.004), 6 (P = 0.132), and 12 (P = 0.036) hours, post operatively.

Conclusions: Prophylactic gabapentin administration could be considered as an effective and safe intervention to reduce occurrence and severity of PLSP after gynecologic laparoscopic cystectomy.

Keywords: Gabapentin; Laparoscopy; Shoulder Pain; Visual Analog Scale.

Figures

Figure 1.. VAS Scores for PLSP at…
Figure 1.. VAS Scores for PLSP at Two, Six and Twelve Hours After Surgery in the Study Groups
1VAS: visual analog scale; 2 PLPS: post laparoscopic shoulder pain.

References

    1. Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367(9522):1618–25. doi: 10.1016/S0140-6736(06)68700-X.
    1. Wadlund DL. Laparoscopy: risks, benefits and complications. Nurs Clin North Am. 2006;41(2):219–29. doi: 10.1016/j.cnur.2006.01.003.
    1. Wills VL, Hunt DR. Pain after laparoscopic cholecystectomy. Br J Surg. 2000;87(3):273–84. doi: 10.1046/j.1365-2168.2000.01374.x.
    1. Cason CL, Seidel SL, Bushmiaer M. Recovery from laparoscopic cholecystectomy procedures. AORN J. 1996;63(6):1106-8.
    1. Phelps P, Cakmakkaya OS, Apfel CC, Radke OC. A simple clinical maneuver to reduce laparoscopy-induced shoulder pain: a randomized controlled trial. Obstet Gynecol. 2008;111(5):1155–60. doi: 10.1097/AOG.0b013e31816e34b4.
    1. Nyerges A. Pain Mechanisms in Laparoscopic Surgery. Semin Laparosc Surg. 1994;1(4):215–8. doi: 10.1053/SLAS00100215.
    1. Berberoglu M, Dilek ON, Ercan F, Kati I, Ozmen M. The effect of CO2 insufflation rate on the postlaparoscopic shoulder pain. J Laparoendosc Adv Surg Tech A. 1998;8(5):273–7.
    1. Sarli L, Costi R, Sansebastiano G, Trivelli M, Roncoroni L. Prospective randomized trial of low-pressure pneumoperitoneum for reduction of shoulder-tip pain following laparoscopy. Br J Surg. 2000;87(9):1161–5. doi: 10.1046/j.1365-2168.2000.01507.x.
    1. Mouton WG, Bessell JR, Otten KT, Maddern GJ. Pain after laparoscopy. Surg Endosc. 1999;13(5):445–8.
    1. Ben-Menachem E. Pregabalin pharmacology and its relevance to clinical practice. Epilepsia. 2004;45 Suppl 6:13–8. doi: 10.1111/j.0013-9580.2004.455003.x.
    1. Martin DJ, McClelland D, Herd MB, Sutton KG, Hall MD, Lee K, et al. Gabapentin-mediated inhibition of voltage-activated Ca2+ channel currents in cultured sensory neurones is dependent on culture conditions and channel subunit expression. Neuropharmacology. 2002;42(3):353–66.
    1. Qin N, Yagel S, Momplaisir ML, Codd EE, D'Andrea MR. Molecular cloning and characterization of the human voltage-gated calcium channel alpha(2)delta-4 subunit. Mol Pharmacol. 2002;62(3):485–96.
    1. Hurley RW, Cohen SP, Williams KA, Rowlingson AJ, Wu CL. The analgesic effects of perioperative gabapentin on postoperative pain: a meta-analysis. Reg Anesth Pain Med. 2006;31(3):237–47. doi: 10.1016/j.rapm.2006.01.005.
    1. Seib RK, Paul JE. Preoperative gabapentin for postoperative analgesia: a meta-analysis. Can J Anaesth. 2006;53(5):461–9. doi: 10.1007/BF03022618.
    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. doi: 10.1016/j.pain.2006.06.018.
    1. Peng PW, Wijeysundera DN, Li CC. Use of gabapentin for perioperative pain control -- a meta-analysis. Pain Res Manag. 2007;12(2):85–92.
    1. Tiippana EM, Hamunen K, Kontinen VK, Kalso E. Do surgical patients benefit from perioperative gabapentin/pregabalin? A systematic review of efficacy and safety. Anesth Analg. 2007;104(6):1545–56. doi: 10.1213/01.ane.0000261517.27532.80.
    1. Kojima Y, Yokota S, Ina H. Shoulder pain after gynaecological laparoscopy caused by arm abduction. Eur J Anaesthesiol. 2004;21(7):578–9.
    1. Shrivastav P, Nadkarni P, Craft I. Prevention of shoulder pain after laparoscopy. Lancet. 1992;339(8795):744.
    1. Yousefshahi F, Dahmardeh AR, Khajavi M, Najafi A, Khashayar P, Barkhordari K. Effect of dexamethasone on the frequency of postdural puncture headache after spinal anesthesia for cesarean section: a double-blind randomized clinical trial. Acta Neurol Belg. 2012;112(4):345–50. doi: 10.1007/s13760-012-0065-6.
    1. Etezadi F, Yousefshahi F, Khajavi M, DAVARI TF, RAHAT DA, Najafi A, Davari-Tanha. Post Dural Puncture Headache after Cesarean Section, a Teaching Hospital Experience. J Fam Reprod Health. 2012;6(1):17–21.
    1. Maneuf YP, Gonzalez MI, Sutton KS, Chung FZ, Pinnock RD, Lee K. Cellular and molecular action of the putative GABA-mimetic, gabapentin. Cell Mol Life Sci. 2003;60(4):742–50.
    1. Mathiesen O, Moiniche S, Dahl JB. Gabapentin and postoperative pain: a qualitative and quantitative systematic review, with focus on procedure. BMC Anesthesiol. 2007;7:6. doi: 10.1186/1471-2253-7-6.
    1. Peng PW, Li C, Farcas E, Haley A, Wong W, Bender J, et al. Use of low-dose pregabalin in patients undergoing laparoscopic cholecystectomy. Br J Anaesth. 2010;105(2):155–61. doi: 10.1093/bja/aeq116.
    1. Dierking G, Duedahl TH, Rasmussen ML, Fomsgaard JS, Moiniche S, Romsing J, et al. Effects of gabapentin on postoperative morphine consumption and pain after abdominal hysterectomy: a randomized, double-blind trial. Acta Anaesthesiol Scand. 2004;48(3):322–7. doi: 10.1111/j.0001-5172.2004.0329.x.
    1. Sen H, Sizlan A, Yanarates O, Emirkadi H, Ozkan S, Dagli G, et al. A comparison of gabapentin and ketamine in acute and chronic pain after hysterectomy. Anesth Analg. 2009;109(5):1645–50. doi: 10.1213/ANE.0b013e3181b65ea0.
    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(1-2):191–200. doi: 10.1016/j.pain.2004.10.008.
    1. Jokela R, Ahonen J, Tallgren M, Haanpaa M, Korttila K. Premedication with pregabalin 75 or 150 mg with ibuprofen to control pain after day-case gynaecological laparoscopic surgery. Br J Anaesth. 2008;100(6):834–40. doi: 10.1093/bja/aen098.
    1. Chang SH, Lee HW, Kim HK, Kim SH, Kim DK. An evaluation of perioperative pregabalin for prevention and attenuation of postoperative shoulder pain after laparoscopic cholecystectomy. Anesth Analg. 2009;109(4):1284–6. doi: 10.1213/ane.0b013e3181b4874d.
    1. Imani F, Rahimzadeh P. Gabapentinoids: gabapentin and pregabalin for postoperative pain management. Anesth Pain Med. 2012;2(2):52–3. doi: 10.5812/aapm.7743.
    1. Nutthachote P, Sirayapiwat P, Wisawasukmongchol W, Charuluxananan S. A randomized, double-blind, placebo-controlled trial of oral pregabalin for relief of shoulder pain after laparoscopic gynecologic surgery. J Minim Invasive Gynecol. 2014;21(4):669–73. doi: 10.1016/j.jmig.2014.01.018.

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