[Skip to Content]
[Skip to Content Landing]

Effect of Perioperative Gabapentin Use on Postsurgical Pain in Patients Undergoing Head and Neck Mucosal SurgeryA Randomized Clinical Trial

Educational Objective
To investigate gabapentin use in patients undergoing large head and neck surgeries associated with postoperative pain.
1 Credit CME
Key Points

Question  Can perioperative pain control be improved with the addition of gabapentin to traditional narcotic medication regimens in patients undergoing mucosal head and neck surgery?

Findings  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.

Meaning  Patients who undergo head and neck mucosal surgery and receive perioperative gabapentin treatment perceive less postoperative pain.

Abstract

Importance  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.

Objective  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.

Results  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.

Trial Registration  ClinicalTrials.gov Identifier: NCT02926573

Sign in to take quiz and track your certificates

Buy This Activity
Article Information

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 (piccirij@wustl.edu).

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.

References
1.
Levine  A, Govindaraj  S, DeMaria  S, eds.  Anesthesiology and Otolaryngology. New York, NY: Springer; 2013.
2.
Pauloski  BR.  Rehabilitation of dysphagia following head and neck cancer.  Phys Med Rehabil Clin N Am. 2008;19(4):889-928, x.PubMedGoogle ScholarCrossref
3.
Lee  JS, Hu  HM, Edelman  AL,  et al.  New persistent opioid use among patients with cancer after curative-intent surgery.  J Clin Oncol. 2017;35(36):4042-4049.PubMedGoogle ScholarCrossref
4.
Kehlet  H.  Multimodal approach to postoperative recovery.  Curr Opin Crit Care. 2009;15(4):355-358.PubMedGoogle ScholarCrossref
5.
Schmidt  PC, Ruchelli  G, Mackey  SC, Carroll  IR.  Perioperative gabapentinoids: choice of agent, dose, timing, and effects on chronic postsurgical pain.  Anesthesiology. 2013;119(5):1215-1221.PubMedGoogle ScholarCrossref
6.
Rafiq  S, Steinbrüchel  DA, Wanscher  MJ,  et al.  Multimodal analgesia versus traditional opiate based analgesia after cardiac surgery, a randomized controlled trial.  J Cardiothorac Surg. 2014;9:52.PubMedGoogle ScholarCrossref
7.
Kehlet  H, Jensen  TS, Woolf  CJ.  Persistent postsurgical pain: risk factors and prevention.  Lancet. 2006;367(9522):1618-1625.PubMedGoogle ScholarCrossref
8.
Kong  VK, Irwin  MG.  Gabapentin: a multimodal perioperative drug?  Br J Anaesth. 2007;99(6):775-786.PubMedGoogle ScholarCrossref
9.
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):1545-1556.PubMedGoogle ScholarCrossref
10.
Paul  JE, Nantha-Aree  M, Buckley  N,  et al.  Randomized controlled trial of gabapentin as an adjunct to perioperative analgesia in total hip arthroplasty patients.  Can J Anaesth. 2015;62(5):476-484.PubMedGoogle ScholarCrossref
11.
Hah  J, Mackey  SC, Schmidt  P,  et al.  Effect of perioperative gabapentin on postoperative pain resolution and opioid cessation in a mixed surgical cohort: a randomized clinical trial  [published online December 13, 2017].  JAMA Surg. 2017. doi:10.1001/jamasurg.2017.4915PubMedGoogle Scholar
12.
Chang  CY, Challa  CK, Shah  J, Eloy  JD.  Gabapentin in acute postoperative pain management.  Biomed Res Int. 2014;2014:631756. doi:10.1155/2014/631756.Google Scholar
13.
Clarke  H, Bonin  RP, Orser  BA, Englesakis  M, Wijeysundera  DN, Katz  J.  The prevention of chronic postsurgical pain using gabapentin and pregabalin: a combined systematic review and meta-analysis.  Anesth Analg. 2012;115(2):428-442.PubMedGoogle ScholarCrossref
14.
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):237-247.PubMedGoogle Scholar
15.
Peng  PW, Wijeysundera  DN, Li  CC.  Use of gabapentin for perioperative pain control: a meta-analysis.  Pain Res Manag. 2007;12(2):85-92.PubMedGoogle ScholarCrossref
16.
Seib  RK, Paul  JE.  Preoperative gabapentin for postoperative analgesia: a meta-analysis.  Can J Anaesth. 2006;53(5):461-469.PubMedGoogle ScholarCrossref
17.
Lee  JH, Lee  HK, Chun  NH, So  Y, Lim  CY.  The prophylactic effects of gabapentin on postoperative sore throat after thyroid surgery.  Korean J Anesthesiol. 2013;64(2):138-142.PubMedGoogle ScholarCrossref
18.
Mohammed  MH, Fahmy  AM, Hakim  K.  Preoperative gabapentin augments intraoperative hypotension and reduces postoperative opioid requirements with functional endoscopic sinus surgery.  Egypt J Anaesthes. 2012;28(3):189-192.Google ScholarCrossref
19.
Kazak  Z, Meltem Mortimer  N, Sekerci  S.  Single dose of preoperative analgesia with gabapentin (600 mg) is safe and effective in monitored anesthesia care for nasal surgery.  Eur Arch Otorhinolaryngol. 2010;267(5):731-736.PubMedGoogle ScholarCrossref
20.
Jeon  EJ, Park  YS, Park  SS, Lee  SK, Kim  DH.  The effectiveness of gabapentin on post-tonsillectomy pain control.  Eur Arch Otorhinolaryngol. 2009;266(10):1605-1609.PubMedGoogle ScholarCrossref
21.
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(2):375-378.PubMedGoogle ScholarCrossref
22.
Al-Mujadi  H, A-Refai  AR, Katzarov  MG, Dehrab  NA, Batra  YK, Al-Qattan  AR.  Preemptive gabapentin reduces postoperative pain and opioid demand following thyroid surgery.  Can J Anaesth. 2006;53(3):268-273.PubMedGoogle ScholarCrossref
23.
Chiu  TW, Leung  CC, Lau  EY, Burd  A.  Analgesic effects of preoperative gabapentin after tongue reconstruction with the anterolateral thigh flap.  Hong Kong Med J. 2012;18(1):30-34.PubMedGoogle Scholar
24.
Dort  JC, Farwell  DG, Findlay  M,  et al.  Optimal perioperative care in major head and neck cancer surgery with free flap reconstruction: a consensus review and recommendations from the Enhanced Recovery After Surgery Society.  JAMA Otolaryngol Head Neck Surg. 2017;143(3):292-303. doi:10.1001/jamaoto.2016.2981PubMedGoogle ScholarCrossref
25.
Piccirillo  JF, Tierney  RM, Costas  I, Grove  L, Spitznagel  EL  Jr.  Prognostic importance of comorbidity in a hospital-based cancer registry.  JAMA. 2004;291(20):2441-2447.PubMedGoogle ScholarCrossref
26.
Myles  PS, Myles  DB, Galagher  W,  et al.  Measuring acute postoperative pain using the visual analog scale: the minimal clinically important difference and patient acceptable symptom state.  Br J Anaesth. 2017;118(3):424-429.PubMedGoogle ScholarCrossref
27.
Mikkelsen  S, Hilsted  KL, Andersen  PJ,  et al.  The effect of gabapentin on post-operative pain following tonsillectomy in adults.  Acta Anaesthesiol Scand. 2006;50(7):809-815.PubMedGoogle ScholarCrossref
28.
Breivik  H, Borchgrevink  PC, Allen  SM,  et al.  Assessment of pain.  Br J Anaesth. 2008;101(1):17-24.PubMedGoogle ScholarCrossref
29.
Todd  KH, Funk  KG, Funk  JP, Bonacci  R.  Clinical significance of reported changes in pain severity.  Ann Emerg Med. 1996;27(4):485-489.PubMedGoogle ScholarCrossref
30.
Collins  SL, Moore  RA, McQuay  HJ.  The visual analogue scale: what is moderate pain in millimeters?  Pain. 1997;72(1-2):95-97.PubMedGoogle ScholarCrossref
31.
Hawker  GA, Mian  S, Kendzerska  T, French  M.  Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP).  Arthritis Care Res (Hoboken). 2011;63(11)(suppl 11):S240-S252.PubMedGoogle ScholarCrossref
32.
Bodian  CA, Freedman  G, Hossain  S, Eisenkraft  JB, Beilin  Y.  The visual analog scale for pain: clinical significance in postoperative patients.  Anesthesiology. 2001;95(6):1356-1361.PubMedGoogle ScholarCrossref
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_LoginSubscribe_Purchase
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_LoginSubscribe_Purchase
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right

Name Your Search

Save Search
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
jn-learning_Modal_SaveSearch_NoAccess_Purchase

Lookup An Activity

or

My Saved Searches

You currently have no searches saved.

With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Topics
State Requirements