Abstract
Postoperative pain is a problem that plagues physicians and has since the dawn of
the surgical arts. Many interventions are available and used as the standard such
as preoperative local anesthetic blocks, opiates, both oral and intravenous, and nonsteroidal
antiinflammatory drugs. Although the temptation often exists to increase the postoperative
opiate dose, opiate abuse is an increasing problem. This abuse has fueled the search
for nonopiate pain adjuncts. Gabapentinoids have been shown to both decrease postoperative
pain and, secondarily, decrease opiate dependence. This is a growing field in medical
research, although it is relatively lacking in the specialty of lower extremity orthopedic
surgery. A PubMed query was performed for related articles, which found only 8 related
to lower extremity orthopedic surgery, and of these, none addressed the foot or ankle.
Studies involving chronic pain, nonorthopedic surgery, orthopedic procedures proximal
to and including the hip, studies involving only pregabalin, and studies regarding
cancer pain were excluded. The results from our literature review are encouraging
regarding the addition of gabapentin as a regular, perioperative adjunctive pain medication
because all studied reported data evaluating preoperative administration have shown
a statistically significant reduction in postoperative pain and opiate consumption.
Level of Clinical Evidence
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of Foot and Ankle SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Non-opioid IV adjuvants in the perioperative period: pharmacological and clinical aspects of ketamine and gabapentinoids.Pharmacol Res. 2012; 65: 411-429
- Gabapentin: pharmacology and its use in pain management.Anaesthesia. 2002; 57: 451-462
- Perioperative gabapentinoids.Anesthesiology. 2013; 119: 1215-1221
- New modalities of pain treatment after outpatient orthopaedic surgery.Orthop Traumatol Surg Res. 2016; 102: S121-S124
- Gabapentin and postoperative pain—a systematic review of randomized controlled trials.Pain. 2006; 126: 91-101
- The analgesic effects of perioperative gabapentin on postoperative pain: a meta-analysis.Reg Anesth Pain Med. 2006; 31: 237-247
- Perioperative gabapentin reduces 24 h opioid consumption and improves in-hospital rehabilitation but not post-discharge outcomes after total knee arthroplasty with peripheral nerve block.Br J Anaesth. 2014; 113: 855-864
- Gabapentin decreases morphine consumption and improves functional recovery following total knee arhthroplasty.Pain Res Manage. 2009; 14: 217-222
- Preoperative gabapentin decreases anxiety and improves early functional recovery from knee surgery.Anesth Analg. 2005; 100: 1394-1399
- Is gabapentin effective on pain management after arthroscopic anterior cruciate ligament reconstruction? A triple blinded randomized controlled trial.Arch Bone Joint Surg. 2013; 1: 18-22
- Gabapentin does not improve multimodal analgesia outcomes for total knee arthroplasty: a randomized controlled trial.Can J Anaesth. 2013; 60: 423-431
- Effect of pre-emptive gabapentin on postoperative pain following lower extremity orthopaedic surgery under spinal anesthesia.Singapore Med J. 2011; 52: 879-882
- Pre-emptive gabapentin significantly reduces postoperative pain and morphine demand following lower extremity orthopaedic surgery.Singapore Med J. 2007; 48: 748-751
- Gabapentin does not appear to improve postoperative pain and sleep patterns in patients who concomitantly receive regional anesthesia for lower extremity orthopedic surgery: a randomized control trial.Pain Res Manag. 2017; 2017: 2310382
- Perioperative interventions to reduce chronic postsurgical pain.J Reconstr Microsurg. 2013; 29: 213-222
- The analgesic effect of gabapentin and mexiletine after breast surgery for cancer.Anesth Analg. 2002; 95: 985-991
- Evaluation of efficacy of the perioperative administration of venlafaxine or gabapentin on acute and chronic postmastectomy pain.Clin J Pain. 2010; 26: 381-385
- Adding gabapentin to a multimodal regimen does not reduce acute pain, opioid consumption or chronic pain after total hip arthroplasty.Acta Anaesthesiol Scand. 2009; 53: 1073-1083
- The effects of gabapentin on acute and chronic postoperative pain after coronary artery bypass graft surgery.J Cardiothorac Vasc Anesth. 2011; 25: 824-829
Article info
Publication history
Published online: May 07, 2018
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
Copyright
© 2018 by the American College of Foot and Ankle Surgeons. All rights reserved.
