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Can perioperative pain control be improved with the addition of gabapentin to traditional narcotic medication regimens in patients undergoing mucosal head and neck surgery?
In this randomized clinical trial, compared with a placebo group of 46 individuals, 44 patients who received 300 mg twice daily of perioperative gabapentin had no difference in narcotic use but experienced less subjective pain.
Patients who undergo head and neck mucosal surgery and receive perioperative gabapentin treatment perceive less postoperative pain.
Effective postoperative pain management increases patient satisfaction, reduces cost, reduces morbidity, and shortens hospitalizations. Previous studies investigating multimodal pain therapy in otolaryngology patients focused on homogenous patient groups with short postoperative follow-up times.
To investigate the effect of perioperative gabapentin treatment on postsurgical pain in patients undergoing head and neck mucosal surgery.
Design, Setting, and Participants
Adults undergoing head and neck mucosal surgery from July 25, 2016, through June 19, 2017, were included in this double-blinded, placebo-controlled randomized clinical trial and randomized to receive gabapentin, 300 mg twice daily, or placebo before surgery and up to 72 hours after surgery.
Main Outcomes and Measures
Primary outcome was hourly narcotic use calculated in morphine equivalents. Secondary outcomes included subjective visual analog scale pain scores captured for resting, coughing, and swallowing using a 0- to 100-mm scale (a 100-mm line anchored with no pain on the left end and worst possible pain on the right end). A change of 10 mm or more was deemed to be clinically meaningful. Additional secondary outcome measures included degree of pain control, patient satisfaction, and adverse effects.
Of the 110 patients randomized to receive gabapentin or placebo, 11 and 10 withdrew from each group, respectively. Ninety patients were then analyzed: 44 in the gabapentin group (mean [SD] age, 61.1 [10.0] years; 33 [75%] male; 40 [91%] white) and 46 in the placebo group (mean [SD] age, 60.9 [11.3] years; 35 [78%] male; 43 [94%] white). Both groups had similar self-reported levels of preoperative pain and narcotic effectiveness. A median difference of 0.26 mg/h of morphine (95% CI, −0.27 to 0.94 mg/h) was found between groups. After controlling for comorbidity and self-reported baseline pain levels, mixed model analysis found the difference in marginal means of visual analog scale scores between groups to be lower in the gabapentin group compared with the placebo group for all categories (rest difference, 7.9 mm; 95% CI, −0.4 to 16.2 mm; cough difference, 8.9 mm; 95% CI, −0.5 to 18.3 mm; swallow difference, 9.4 mm; 95% CI, −1.2 to 20.0 mm). More patients in the gabapentin group reported that pain was always well controlled than in the placebo group (difference, 9.2%; 95% CI, −21% to 3%). Gabapentin and placebo groups reported similar levels of satisfaction with pain control (difference, 2%; 95% CI, −11% to 15%). There was no clinically meaningful difference in reported nausea between the 2 groups (difference, 6%; 95% CI, −14% to 26%).
Conclusion and Relevance
Perioperative gabapentin given 300 mg twice daily did not result in reduced narcotic use, but results were compatible with clinically meaningful reductions in pain scores. Satisfaction with pain control and adverse effects were similar between groups.
ClinicalTrials.gov Identifier: NCT02926573
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Accepted for Publication: March 19, 2018.
Corresponding Author: Jay F. Piccirillo, MD, Department of Otolaryngology, Washington University School of Medicine in St Louis, 660 S Euclid Ave, McMillan Bldg, Campus Box 8115-06-805F, St Louis, MO 63110 (email@example.com).
Published Online: April 19, 2018. doi:10.1001/jamaoto.2018.0282
Author Contributions: Drs Townsend and Kallogjeri had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Townsend, Liou, Lindburg, Jackson, Bottros, Nussenbaum.
Acquisition, analysis, or interpretation of data: Townsend, Liou, Kallogjeri, Schoer, Scott-Wittenborn, Lindburg, Nussenbaum, Piccirillo.
Drafting of the manuscript: Townsend, Kallogjeri, Piccirillo.
Critical revision of the manuscript for important intellectual content: Townsend, Liou, Kallogjeri, Schoer, Scott-Wittenborn, Lindburg, Jackson, Bottros, Nussenbaum, Piccirillo.
Statistical analysis: Townsend, Kallogjeri.
Obtained funding: Townsend, Bottros.
Administrative, technical, or material support: Townsend, Liou, Scott-Wittenborn, Lindburg, Bottros, Nussenbaum, Piccirillo.
Study supervision: Jackson, Bottros, Nussenbaum, Piccirillo.
Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
Funding/Support: Funding for this study was provided by grant 36435 from the Foundation for Barnes-Jewish Hospital, St Louis, Missouri (Dr Nussenbaum).
Role of the Funder/Sponsor: The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Disclaimer: Dorina Kallogjeri, MD, MPH, is Statistics Editor and Jay F. Piccirillo, MD, is Editor of JAMA Otolaryngology–Head & Neck Surgery, but they were not involved in any of the decisions regarding review of the manuscript or its acceptance.
Meeting Presentation: This study was presented at the AHNS 2018 Annual Meeting; April 19, 2018; National Harbor, Maryland.
Additional Contributions: We acknowledge the research office coordinators with the Department of Radiology, Washington University School of Medicine in St Louis, St Louis, Missouri. Drs Townsend and Liou acknowledge the clinical research support from the Otolaryngology Surgical Outcomes and Quality Improvement Unit and the Clinical Outcomes Research Office at the Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri.
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