Gabapentin 250 mg is statistically superior to placebo in the treatment of established acute postoperative pain, but the NNT of 11 for at least 50% pain relief over 6 hours with gabapentin 250 mg is of limited clinical value and inferior to commonly used analgesics. Gabapentin and the related, more potent compound pregabalin have been shown to be beneficial in the treatment of neuropathic pain as well as postoperative pain following spinal surgery and hysterectomy. Surgeons have made substantial efforts to decrease postoperative opioid prescribing, largely because it can lead to prolonged use. These efforts include adoption of non-opioid pain medication including gabapentin. Gabapentin, an antiepileptic drug, is frequently used off-label to manage postoperative nerve pain due to its antiallodynic and antihyperalgesic properties. This article synthesizes research findings on the optimal dosage and efficacy of gabapentin for managing nerve pain after surgery. Yu L, Ran B, Li M, Shi Z. Gabapentin and pregabalin in the management of postoperative pain after lumbar spinal surgery: a systematic review and meta-analysis. Spine. 2013;38(22):1947–52. doi: 10.1097/BRS.0b013e3182a69b90. One article described the effects of gabapentin on traumatic nerve injury or post-surgery nerve pain and found that gabapentin provided significantly better pain relief when compared to placebo, with more patients having at least a 30% pain reduction and less sleep interference due to pain. 28 Dolgun et. al. assessed the acute neuropathic pain Gabapentin, pregabalin, and duloxetine have potential to further decrease post-operative pain and lower opioid dependency. This review creates an opening for further research in hand surgery to assess an updated protocol for pain management to reduce opioid dependency. I discovered quite accidentally that Gabapentin made quite a difference in my pain level after surgery for broken hip. I have it on hand for nerve pain but this was an unexpected surprise. I know there are off-label uses for it. However, it shares key characteristics with neuropathic pain which gabapentin, an anticonvulsant, has been proven to effectively treat. To our knowledge, this is the first prospective study assessing the use of gabapentin in cardiothoracic surgery patients. Gabapentin and other anticonvulsant medications have been established as an effective treatment for chronic neuropathic pain and are commonly used for such conditions as herpetic neuralgia, diabetic neuropathy, and phantom limb pain following amputation. Peri-operative gabapentin administration is effective in reducing pain scores, opioid requirements and opioid-related adverse effects in the first 24 hours after surgery. No serious side-effects were observed, though sedation was associated with gabapentin use. Similarly, aside from 24 h after surgery, gabapentin significantly reduced pain with movement (25–27,31,34,35,37,38) by 18% to 28% (VAS 8.2 mm to 10.2 mm) after surgery . The pooled effects on VAS pain scores displayed significant heterogeneity, which was not explained by subgroup analyses based on surgical procedure, gabapentin dose or study The Cleveland Clinic study had patients take a preemptive dose of three drugs: acetaminophen, the nerve pain medication gabapentin and the NSAID celecoxib (Celebrex). “Giving non-opioid pain medications before may help prevent the cascade of pain-causing chemicals that comes from your central nervous system after surgery,” explains Memtsoudis. How Long Does Gabapentin Take to Work for Nerve Pain? After taking a dose, IR gabapentin starts to work in the body within two to three hours. However, the full effects of gabapentin can take one to two weeks to become noticeable, and some people may need to wait longer to experience significant pain reduction. Would you want to take Lyrica (pregabalin) or Neurontin (gabapentin) for pain relief after a major surgery? Both drugs belong to a class of nerve medication called gabapentinoids that are increasingly being prescribed to patients perioperatively (after surgery) as an alternative to opioid medication. Gabapentin for other types of nerve pain. Gabapentin can also treat nerve pain from PHN, which is the most common complication of shingles. It’s also used off-label to treat diabetes-related nerve pain. If you have nerve pain from other causes — like back injury, nerve injury, or after surgery — it still may help. What Helps With Nerve Pain After Surgery? Treatment options for nerve damage and pain after surgery include: Orthobiologics (e.g. platelet-rich plasma — PRP) Physical therapy may help. Medications that are commonly used to treat nerve damage after surgery include: Neurontin (Gabapentin) (12) Lyrica (Pregabalin) (13) Elavil (Amitriptyline) (14) Some randomized controlled studies have carried out to evaluate the effects of gabapentin on pain relief after TKA. However, no solid result was made about it. The purpose of this Meta-Analysis of Randomized Controlled Trials (RCTs) was to estimate the overall effect of pain control of gabapentin versus placebo after a TKA. We recommend being selective with regard to using gabapentinoids for acute postoperative pain management after careful consideration of the potential side effect profile based on patient comorbidities as well as the expected severity of postoperative pain.
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