加巴喷丁术前给药可改善行开颅术患者术后急性镇痛效果：随机对照实验
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Preoperative Gabapentin Administration Improves Acute Postoperative Analgesia in Patients Undergoing Craniotomy: A Randomized Controlled Trial
背景与目的
加巴喷丁是一种辅助抗癫痫药物,可减少重大手术急性术后疼痛。然而，加巴喷丁对经枕下或颞下开颅术术后疼痛的影响尚不清楚。
方 法
本实验采用单中心、随机、安慰剂对照、双盲研究。将122例经枕下或颞下入路行择期开颅手术的患者随机分为安慰剂组和加巴喷丁组。加巴喷丁组于手术前一天晚上及麻醉诱导前2h均口服加巴喷丁600 mg，安慰剂组服用维生素B。主要观察指标是术后24小时运动时的疼痛评分。次要观察指标包括其他时点的疼痛评分，恶心和呕吐的发生率和镇静及镇痛所消耗药物的剂量。
结 果
加巴喷丁能显著降低术后24h内安静时(p=0.001)和运动时(p=0.000)的术后急性疼痛评分；然而，它在48h时对急性疼痛评分没有影响。加巴喷丁可减少术后呕吐(p=0.047)、减少止吐剂的使用 (p=0.033)和提高术后2h镇静评分(p<0.033)。此外，加巴喷丁还可降低术中丙泊酚(0.7mg/kg/h，p=0.021)和瑞芬太尼(1.3µg/kg/h，p=0.025)的平均用量；然而，他对术后阿片药物的用量无显著影响。
结 论
术前使用加巴喷丁可明显减轻经枕下或颞下开颅手术患者急性术后疼痛，同时减少呕吐的发生率。然而，当使用加巴喷丁进行多模式镇痛时应注意术后早期镇静。
原始文献摘要
Zeng M, Dong J, Lin N, et al. Preoperative Gabapentin Administration Improves Acute Postoperative Analgesia in Patients Undergoing Craniotomy: A Randomized Controlled Trial.[J].J Neurosurg Anesthesiol 2018 Aug 21.
Background: Gabapentin is an adjuvant antiepileptic agent and helps to reduce acute postoperative pain in several surgery settings. However, the effect of gabapentin on postoperative pain from suboccipital or subtemporal craniotomy is not clear.
Methods: The study was a single-center, randomized, placebocontrolled, and double-blinded trial. A total of 122 patients undergoing elective craniotomy by a suboccipital or subtemporal approach were randomly allocated to a placebo group and gabapentin group . The patients received gabapentin (600 mg, orally) the night before surgery and 2 hours before anesthesia induction in the gabapentin group, and patients received vitamin B in the placebo group. The primary outcome was the postoperative pain score on movement at 24 hours. The secondary outcomes included the pain score at other time points, incidence of nausea and vomiting, sedation, and analgesic consumption.
Results: Gabapentin significantly decreased the postoperative acute pain scores at rest (P=0.001) and on movement (P=0.000) within 24 hours; however, it did not have an effect at 48 hours. Gabapentin decreased postoperative vomiting (P=0.047) and rescue antiemetic use (P=0.033), whereas it increased the postoperative sedation score at 2 hours (P<0.05). Moreover, gabapentin decreased the mean consumption of intraoperative propofol (0.7 mg/kg/h; P=0.021) and remifentanil (1.3 µg/kg/h; P=0.025); however, it did not influence postoperative opioid consumption.
Conclusions: Preoperative gabapentin significantly alleviated acute postoperative pain and decreased the incidence of vomiting in patients undergoing suboccipital or subtemporal craniotomy. However, more attention should be paid to early postoperative sedation when multimodal analgesia with gabapentin is administered.
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