Townsend M, et al. - Authors evaluated the impact of perioperative gabapentin treatment on postsurgical pain in patients who underwent head and neck mucosal surgery. Reduced narcotic use was not resulted by perioperative administration of gabapentin 300 mg twice daily, but results were compatible with clinically meaningful reductions in pain scores. Between the groups, similar satisfaction with pain control and adverse effects was seen.

Methods

• Experts included the adults undergoing head and neck mucosal surgery from July 25, 2016, through June 19, 2017, 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.
• Hourly narcotic use calculated in morphine equivalents was the primary outcome.
• 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) were the secondary outcomes.
• Reseachers considered a change of 10 mm or more to be clinically meaningful.
• Degree of pain control, patient satisfaction, and adverse effects were included in additional secondary outcome measures.

Results

• As per data, out of the 110 patients randomized to receive gabapentin or placebo, 11 and 10 withdrew from each group, respectively.
• Findings suggested that 90 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).
• Results demonstrated both groups to have similar self-reported levels of preoperative pain and narcotic effectiveness.
• Between groups, a median difference of 0.26 mg/h of morphine (95% CI, -0.27 to 0.94 mg/h) was found.
• Authors noted that 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).
• Compared to the placebo group, more patients in the gabapentin group reported that pain was always well controlled (difference, 9.2%; 95% CI, -21% to 3%).
• Similar levels of satisfaction with pain control were reported by gabapentin and placebo groups (difference, 2%; 95% CI, -11% to 15%) .
• Between the 2 groups, there was no clinically meaningful difference in reported nausea (difference, 6%; 95% CI, -14% to 26%).