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Gabapentin
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| Soltanzadeh M et al., 20112626 Soltanzadeh M, Ebad A, Pipelzadeh M, et al. Gabapentin may relieve post-coronary artery bypass graft pain: a double blind randomized clinical trial. Iran Cardiovasc Res J. 2011;5:79-82.
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60 men aged 20-70 years posted for CABG |
Oral gabapentin 800 mg 2 h before surgery and 400 mg 2 h after extubation (n = 30), vs. placebo (n = 30) |
Morphine |
Pain scores both at rest and during coughing were significantly lower in the gabapentin group (p = 0.02).
Hemodynamic changes (HR, SBP, DBP) and the incidence of nausea, vomiting and respiratory depression within 24 h were comparable between the two groups. |
Postoperative mechanical ventilation was significantly (p = 0.03) longer (5.4 ± 1.7 h) in gabapentin than in control group (4.4 ± 1.6 h).
The number of over-sedated patients (a sedation score > 2) was higher in gabapentin group. |
| Menda et al., 20102323 Menda F, Koner O, Sayin M, et al. Effects of single-dose gabapentin on postoperative pain and morphine consumption after cardiac surgery. J Cardiothorac Vasc Anesth. 2010;24:808-13.
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60 young men undergoing CABG |
Oral gabapentin 600 mg 2 h before surgery (n = 30), vs. placebo (n = 30) |
Morphine PCA, paracetamol |
Total morphine consumption was lower in the GABA group (6.7 ± 2.5) than the placebo (PLA) group (15.5 ± 4.6 mg,p < 0.01) at 24 h.
Pain scores at rest were significantly lower in the GABA group throughout the study period (p < 0.05).
Pain scores at 2, 6, and 12 h during coughing were significantly lower in the GABA group (p < 0.05), whereas pain scores during coughing were similar at 18, 24, and 48 h between the groups. |
The postoperative mechanical ventilation period was significantly prolonged in the GABA group (6.6 ± 1.2 h) compared with the PLA group (5.5 ± 1 h,p < 0.01).
The number of over sedated patients (patients with a Ramsay score > 2) was higher in the
GABA group at 2, 6, and 12 h of study.
There was lower incidence of nausea in the GABA group (p = 0.02). |
| Rapchuk et al., 20102525 Rapchuk IL, O'Connell L, Liessmann CD, et al. Effect of gabapentin on pain after cardiac surgery: a randomised, double-blind, placebo-controlled trial. Anaesth Intensive Care. 2010;38:445-51.
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60 patients undergoing median sternotomy |
Oral gabapentin 1200 mg 2 h before surgical incision and 600 mg twice a day for the next two postoperative days (n = 30), vs. placebo (n = 30). |
Fentanyl PCA, paracetamol, tramadol, pethidine, NSAIDs |
Total PCA fentanyl usage in the first 48 h was similar in two groups.
VAS scores recorded at 12, 24, 48 and 72 h at rest and movement were not significantly different. |
Sleep scores, number of antiemetic doses in first 48 h, adjunctive pain medications used and score achieved on the quality of recovery questionnaire were similar in the two groups.
The incidence of side-effects (arrhythmias, dizziness and sedation) was also similar. |
| Ucak A et al., 20112828 Ucak A, Onan B, Sen H, et al. The effects of gabapentin on acute and chronic postoperative pain after coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth. 2011;25:824-9.
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40 patients with IHD undergoing CABG |
Oral gabapentin 1.2 g·dL-1 1 h before surgery and for 2 days after surgery (n = 20), vs. placebo (n = 20) |
Tramadol, paracetamol |
Postoperative pain scores at 1, 2, and 3 days were lower in the gabapentin group (p < 0.05). Pain scores at 1 and 3 months postoperatively were also lower in the gabapentin group (p > 0.05).
Consumption of rescue analgesic (tramadol) within 24 h after extubation in the gabapentin group was 99.0 ± 53.8 mg vs. 149.4 ± 72.5 mg in the placebo group (p < 0.05). |
There were no differences in the incidence of side effects and time to extubation. |
|
Pregabalin
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| Joshi et al., 20132222 Joshi SS, Jagadeesh AM. Efficacy of perioperative pregabalin in acute and chronic post-operative pain after off-pump coronary artery bypass surgery: a randomized, double-blind placebo controlled trial. Ann Card Anaesth. 2013;16:180-5.
|
40 patients aged 30-65 years undergoing primary off-pump CABG |
Oral pregabalin 150 mg 2 h before induction and 75 mg every 12 h for 2 post-operative days (n = 20), vs. placebo (n = 20) |
Tramadol, paracetamol, diclofenac |
Pain-scores at rest at 6, 12, 24 and 36 h from extubation and pain scores at deep breath at 4, 6, 12, 24 and 36 h from extubation were less in pregabalin treated patients (p < 0.05). Rescue analgesic (tramadol) consumption was reduced by 60% in pregabalin group (p < 0.001). The pain severity scores were higher in the control group at 12, 24 and 36 h (p < 0.05). Pain at rest and deep breathing at 1 month and 3 months after surgery were comparable among the groups. |
Sedation (RASS), incidences of respiratory depression and nausea were comparable. Extubation time, duration of ICU and hospital stay were also similar. Peak inspiratory flow rates as assessed by incentive spirometry were higher in pregabalin group as compared to control group at 12, 24 and 36 h from extubation (p < 0.05) |
| Pesonen et al., 20112424 Pesonen A, Suojaranta-Ylinen R, Hammaren E, et al. Pregabalin has an opioid-sparing effect in elderly patients after cardiac surgery: a randomized placebo-controlled trial. Br J Anaesth. 2011;106:873-81.
|
70 patients aged 75 years or older, undergoing primary elective CABG or single valve repair or replacement with CPB |
Oral pregabalin 150 mg 1 h before surgery and 75 mg twice daily for 5 postoperative days (n = 35), vs. placebo (n = 35) |
Oxycodone |
Percentage of patients requiring analgesia was significantly lower at 2, 10, and 12 h after extubation in the pregabalin group (p < 0.05). Pregabalin also reduced consumption of parenteral oxycodone during 16 h after extubation by 43% and total oxycodone consumption from extubation to the end of the fifth postoperative day by 48%. The incidence of pain during movement was significantly lower in the pregabalin group at 3 months postoperatively, but pain after 1 month was similar. |
RASS and MMSE scores were similar between the groups and CAM-ICU scores were significantly lower in the placebo group on the 1st postoperative day. Time to extubation was significantly longer in the pregabalin group (638 ± 285 vs. 500 ± 233 min;p < 0.05). Incidence of nausea and vomiting was comparable. |
| Sundar et al., 20122727 Sundar AS, Kodali R, Sulaiman S, et al. The effects of preemptive pregabalin on attenuation of stress response to endotracheal intubation and opioid-sparing effect in patients undergoing off-pump coronary artery bypass grafting. Ann Card Anaesth. 2012;15:18-25.
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60 adult patients scheduled for elective off-pump CABG |
Oral pregabalin 150 mg 1 h before surgery (n = 30), vs. placebo (n = 30) |
Fentanyl |
VAS measured at 6, 12, and 24 h after surgery and fentanyl consumption up to 24 h after surgery was similar between the groups. |
Ramsay sedation scores at 6, 12, and 24 h after surgery were similar between the groups. Duration of ventilation and ICU stay and incidences of nausea, vomiting and dizziness were also comparable. |
| Ziyaeifard et al., 20152929 Ziyaeifard M, Mehrabanian MJ, Faritus SZ, et al. Premedication with oral pregabalin for the prevention of acute postsurgical pain in coronary artery bypass surgery. Anesth Pain Med. 2015;5:e24837.
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60 patients older than 20 years posted for elective CABG |
Oral pregabalin 150 mg 2 h before surgery (n = 30), vs. placebo (n = 30) |
Morphine |
Pain scores were significantly lower in the pregabalin group at 4, 12, and 24 h of surgery (p < 0.05); but morphine consumption was similar between the groups. |
Duration of ICU stay was similar. |
