Can Gabapentin Help Reduce Postoperative Pain in Arthroscopic Rotator Cuff Repair? A Prospective, Randomized, Double-Blind Study

doi:10.1016/j.arthro.2009.11.010

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 26, Issue 9, Supplement, September 2010, Pages S106-S111

https://doi.org/10.1016/j.arthro.2009.11.010 Get rights and content

Purpose

The aim of the study was to determine the effect of low-dose gabapentin on postoperative pain management in patients undergoing arthroscopic rotator cuff repair.

Methods

This randomized, double-blinded, placebo-controlled study included 46 patients. The patients were divided into 2 groups according to the drug administered 2 hours before surgery, either 300 mg of gabapentin or placebo. The primary outcome measure was the visual analog scale (VAS) score at 2, 6, 12, and 24 hours postoperatively. The secondary outcome measures were fentanyl consumption and side effects during the first 2 hours in the postanesthesia care unit and then at 6 and 24 hours postoperatively. The patients were evaluated for side effects including nausea, vomiting, respiratory depression, dizziness, drowsiness, voiding difficulty, and pruritus.

Results

The VAS scores at 2, 6, and 12 hours postoperatively were significantly lower in the gabapentin group than in the placebo group (P = .023, P = .019, and P = .022, respectively). The consumption of fentanyl, over a period of 24 hours, was not different in the comparisons between the groups (P = .686). The incidence of side effects was similar in the 2 groups.

Conclusions

A single dose of 300 mg of gabapentin reduced the VAS score during the first 24 hours postoperatively in patients undergoing shoulder arthroscopic rotator cuff repair, without significant side effects when compared with placebo. However, the fentanyl consumption did not differ between the gabapentin and placebo groups.

Level of Evidence

Level I, randomized controlled trial.

Section snippets

Methods

This was a randomized, double-blinded, placebo-controlled study. Patients were recruited from the Department of Orthopaedic Surgery from June 2007 to April 2008. The study was approved by the institutional review board, and informed consent was obtained from all patients.

Forty-six patients (ASA class I and II) who were scheduled for arthroscopic rotator cuff repair were eligible for this study. The exclusion criteria included a known allergy to gabapentin; the presence of any chronic pain

Results

From June 2007 to April 2008, 66 patients who fulfilled the inclusion criteria were considered for inclusion in the study (Fig 1). Of these, 52 were included in the study. Three patients were excluded in each group. Thus 46 patients were enrolled, 23 in the placebo group and 23 in the gabapentin group.

There was no significant difference in demographic data between the groups (Table 1). The VAS scores at 2, 6, and 12 hours postoperatively were significantly lower in the gabapentin group than in

Discussion

The results of this study showed that the VAS scores at 2, 6, and 12 hours postoperatively were significantly lower in the gabapentin group than in the placebo group after arthroscopic rotator cuff repair. However, the fentanyl consumption was similar at each time point in the 2 groups.

A full-thickness rotator cuff tear is 1 of the most common conditions for shoulder joint surgery, and the incidence increases with age.12, 13 After arthroscopic rotator cuff repair, severe pain can occur during

Conclusions

The results of this study suggest that a single dose of 300 mg of gabapentin reduced the VAS score during the first 24 hours postoperatively in patients undergoing shoulder arthroscopic rotator cuff repair, without significant side effects when compared with placebo. However, the fentanyl consumption was similar in the 2 groups.

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Addition of Preoperative Ultrasound-Guided Suprascapular Nerve Block and Axillary Nerve Block to Parecoxib Is More Effective in Early Postoperative Pain Control After Arthroscopic Rotator Cuff Repair: A Prospective Randomized Controlled Study
2024, Arthroscopy - Journal of Arthroscopic and Related Surgery
To prospectively compare pain intensity and patient-reported outcomes (PROs) after arthroscopic rotator cuff repair (ARCR) between patients who received ultrasound-guided suprascapular nerve block (SSNB) and axillary nerve block (ANB) as well as preincisional parecoxib and patients who received preincisional parecoxib only.
Sixty-one patients receiving ARCR between March 2020 and March 2021 were prospectively enrolled. They were randomly assigned to the peripheral nerve block group (group N, n = 30) or control group (group C, n = 31). Two patients in group C were excluded because of miscommunication. All patients were administered 40 mg of parecoxib intravenously prior to induction of anesthesia. SSNB and ANB were performed after general anesthesia in group N, whereas no nerve block was performed in group C. Pain intensity was compared before surgery, as well as immediately, 24 hours, and 2 weeks after surgery. PROs, including the Oxford Shoulder Score, University of California–Los Angeles shoulder score, and Single Assessment Numeric Evaluation score, were compared before and 6 months after surgery.
The numerical rating scale (NRS) score for resting pain was significantly lower in group N (4.9 ± 3.1 vs 7.6 ± 2.5, P < .001) immediately after surgery, but no difference was noted 24 hours after surgery. The resting pain NRS score 2 weeks after surgery was significantly lower in group N (1.4 ± 1.6 vs 2.7 ± 2.7, P = .03), but the scores for movement-evoked pain and night pain were similar. All PROs significantly improved 6 months after surgery in both groups, but there was no difference between the 2 groups.
The addition of preoperative ultrasound-guided SSNB and ANB to parecoxib offered better resting pain control immediately and 2 weeks after ARCR, but there was no benefit for PROs 6 months after surgery.
Level II, prospective randomized controlled trial.
Evolution of Perioperative Pain Management in Shoulder Arthroplasty
2023, Orthopedic Clinics of North America
Perioperative Gabapentin May Reduce Opioid Requirement for Early Postoperative Pain in Patients Undergoing Anterior Cruciate Ligament Reconstruction: A Systematic Review of Randomized Controlled Trials
2023, Arthroscopy - Journal of Arthroscopic and Related Surgery
To evaluate the efficacy of perioperative gabapentin or pregabalin treatment on postoperative pain and opioid requirement reduction in patients undergoing anterior cruciate ligament reconstruction (ACLR).
A systematic review of randomized control trials was conducted evaluating the effect of gabapentin or pregabalin on postoperative pain and opioid requirement for patients undergoing ACLR. The primary outcomes assessed were postoperative pain scores and opioid requirements. Secondary outcomes were complications, side effects, dosage, and timing of intervention.
The initial search query identified 151 studies and 6 studies were included after full-text articles were reviewed. Three studies investigated the use of gabapentin and three studies investigated pregabalin. All three gabapentin studies reported significantly decreased or equivalent pain scores while also significantly reducing or removing total opioid consumption compared to control groups. Pregabalin demonstrated inconsistent efficacy for pain control and opioid consumption parameters across three studies. One study (pregabalin, n = 1) reported significantly increased incidence of dizziness with pregabalin compared to placebo.
There is moderate evidence demonstrating that preoperative gabapentin may be safe and effective in reducing postoperative pain and opioid consumption after ACLR. Gabapentin may be considered when employed as part of a multimodal analgesia regimen; however, the optimal protocol has yet to be determined. Currently, there is limited evidence demonstrating the efficacy of pregabalin on pain and opioid consumption in the setting of ACLR.
Level I, systematic review of Level I Studies
Published Multimodal Anesthetic Protocols Using Gabapentin Risk Substantial Side Effects and Are Not Recommended
2022, Arthroscopy - Journal of Arthroscopic and Related Surgery
Effect of perioperative acetaminophen on pain management in patients undergoing rotator cuff repair: a prospective randomized study
2021, Journal of Shoulder and Elbow Surgery
Limiting opioid use in perioperative pain management is currently an important focus in orthopedic surgery. The ability of acetaminophen to reduce postoperative opioid consumption while providing acceptable pain management has not been thoroughly investigated in patients undergoing rotator cuff repair (RCR).
Patients undergoing primary arthroscopic RCR were prospectively randomized to 1 of 3 treatment groups: Group 1 (control) received both 5 mg of oxycodone every 6 hours as needed and 1000 mg of acetaminophen orally every 6 hours as needed after surgery and had the option to take either medication or both. Group 2 (control) received only 5 mg of oxycodone every 6 hours as needed without any additional acetaminophen after surgery. Group 3 received 1000 mg of acetaminophen orally every 6 hours for 1 day prior to and after surgery, which was subsequently decreased to administration every 8 hours during postoperative days 2-5. Group 3 patients were also allowed to take 5 mg of oxycodone every 6 hours as needed after surgery. All patients received interscalene blocks with liposomal bupivacaine (Exparel). Opioid use, pain scores, side effects, and overall satisfaction were assessed daily for the first week after surgery.
A total of 57 patients (mean age, 57.8 ± 9.55 years) were included in this study. Baseline demographic characteristics including age, sex, and body mass index were similar between the groups (P > .05). Patients in group 3 took significantly fewer narcotics overall (P = .017) and took significantly fewer pills each day compared with group 2. Group 3 also reported significantly better overall pain control compared with the other groups (P = .040). There were no significant differences in overall patient satisfaction between the groups (P > .05). Additionally, there were no significant differences between groups regarding postoperative medication-associated side effects (P > .05).
Perioperative acetaminophen represents an important component of multimodal analgesia in appropriately selected patients undergoing shoulder surgery. In this study, the use of perioperative acetaminophen significantly decreased opioid consumption and improved overall pain control after primary arthroscopic RCR.
Opioid requirement after rotator cuff repair is low with a multimodal approach to pain
2021, Journal of Shoulder and Elbow Surgery
Current practices may aim to blunt rather than understand postoperative pain. Perhaps the most common serious complication of arthroscopic rotator cuff repair (ARCR) is persistence of opiate medication intake. Patients still receive upwards of 80 oxycodone 5 mg pills, or 600 morphine milligram equivalents (MMEs), leading more than 20% of opioid-naïve subjects to continue to fill opioid prescriptions beyond 180 days after surgery. Developing evidence-based guidelines for narcotic prescription after ARCR presents an opportunity for orthopedic surgeons to address the opioid epidemic.
The purpose of this study was (1) to prospectively determine the requirements for opiate medications after ARCR, and (2) to create an evidence-based guideline for postoperative prescription, in contrast to the anecdotal or expert panel recommendations that currently exist. We further investigated whether a liposomal bupivacaine (LB) interscalene never block (ISNB) would reduce pain and opiate consumption compared with standard bupivacaine ISNB (control) for ARCR.
The study enrolled 100 patients who underwent primary ARCR surgery. Patients were provided with postoperative “pain journals” to document their daily pain on a numerical rating scale, satisfaction with pain management using the Likert scale, and track their daily oxycodone 5 mg pill consumption during the 14-day postoperative period. Enrolled patients were further randomized to receiving an LB (experimental) or standard bupivacaine (control) ISNB.
A total of 77% of all patients required fewer than 15 pills postoperatively. The LB group consumed an average of 1.7 fewer pills (13.0 MMEs) on postoperative day (POD) 1 (P = .02) and reported statistically lower pain during PODs 1 and 2 (P = .01 and P = .006), as well as cumulatively throughout the study period (P = .03). In addition, LB patients remained opioid-free at a higher rate (44% vs. 15% in controls, P = .03).
With a multimodal approach, the majority of patients undergoing ARCR can manage postoperative pain with 15 or fewer oxycodone 5 mg tablets (112.5 MMEs) and maintain a high degree of satisfaction. The addition of an LB ISNB may further reduce the consumption of postoperative narcotics compared with a standard ISNB. This study provides evidence that may be used for surgeon guidelines in the effort to reduce opioid prescriptions after ARCR.

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: The authors report no conflict of interest.

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ShoulderA Level I Evidence Study on RC Repair Pain Reduction Using GabapentinCan Gabapentin Help Reduce Postoperative Pain in Arthroscopic Rotator Cuff Repair? A Prospective, Randomized, Double-Blind Study

Purpose

Methods

Results

Conclusions

Level of Evidence

Section snippets

Methods

Results

Discussion

Conclusions

Best Pract Res Clin Anaesthesiol

Arthroscopy

Arthroscopy

Pain

Br J Anaesth

Arthroscopy

Pain

Efficacy and safety of a subacromial continuous ropivacaine infusion for post-operative pain management following arthroscopic rotator cuff surgery: A protocol for a randomised double-blind placebo-controlled trial

BMC Musculoskelet Disord

Patient-controlled analgesia after arthroscopic rotator cuff repair: Subacromial catheter versus intravenous injection

Am J Sports Med

Patient-controlled analgesia in the management of postoperative pain

Drugs

Shoulder
A Level I Evidence Study on RC Repair Pain Reduction Using Gabapentin
Can Gabapentin Help Reduce Postoperative Pain in Arthroscopic Rotator Cuff Repair? A Prospective, Randomized, Double-Blind Study