Ture, H., Sayin, M., Karlikaya, G., Bingol, C.A., Aykac, B., & Ture, U. (2009). The analgesic effect of gabapentin as a prophylactic anticonvulsant drug on postcraniotomy pain: A prospective randomized study. Anesthesia and Analgesia, 109(5),1625–1631.doi:10.1213/ane.0b013e3181b0f18b
To evaluate the effectiveness of gabapentin in treating acute postoperative pain in patients who have undergone craniotomy
For anticonvulsant prophylaxis, patients were randomized to one of two groups. One group received 1200 mg oral gabapentin daily (400 mg three times/day). The other received 300 mg oral gabapentin daily (100 mg three times/day). Patients took medications for seven days before surgery, as part of the surgical regimen, and postoperatively. All patients received postoperative morphine via patient controlled analgesia (PCA); the dose was titrated up to 0.1 mg/kg IV according to the pain rating on a visual analog scale (VAS). Postoperative follow-up included noting the VAS and Ramsay sedation scores, morphine consumption, and seizure activity or other adverse effects at 0, 15, and 30 minutes and at 1, 2, 4, 6, 12, 24, and 48 hours.
Randomized parallel-group trial
Use of gabapentin as a prophylactic anticonvulsant was associated with lower postoperative opioid consumption and lower pain severity. Gabapentin was associated with higher sedation in the immediate postoperative period and a longer time to extubation.
Gabapentin had significant analgesic effects in patients who had undergone craniotomy, but pain relief was associated with increased sedation and longer time to extubation. In patients undergoing neurosurgery, determining causes of increased sedation or delayed extubation can be difficult and critical. Sedation and delayed extubation can contribute to difficulties in clinical care. Future research should investigate the timing and dosage of gabapentin, with the goal of taking advantage of the drug's positive effects while minimizing negative side effects.