The optimal preemptive dose of gabapentin following gynecologic surgery / 대한마취과학회지

BACKGROUND: Gabapentin decreases acute nociceptive pain in animal and human studies when given before surgical incision. Various doses of gabapentin have been used (300-1,200 mg) to measure this preemptive effect. Here, we evaluated the optimal dose of gabapentin for reducing fentanyl consumption and the adverse effects of gabapentin following gynecologic surgery. METHODS: We recruited 100 patients who underwent laparotomy for gynecologic surgery. Patients were randomly divided into 4 groups and received a placebo (control), gabapentin 300 mg (G 300), gabapentin 600 mg (G 600), or gabapentin 1,200 mg (G 1200) 2 h before surgery. Postoperatively, patients received fentanyl via an intravenous patient controlled analgesia device. The cumulative fentanyl doses were recorded 2, 6, 12, 24 h, and 48 h postoperatively, and the sedation scale was recorded in the post anesthetic care unit (PACU). RESULTS: The postoperative fentanyl requirement was lower with gabapentin treatment, but there was no significant differences for the different doses. PACU sedation scores were not different in any group. CONCLUSIONS: Gabapentin has a preemptive effect in gynecologic surgery, but there were no additional fentanyl-sparing benefits at doses above 300 mg. Thus, 300 mg is an optimal dose for decreasing fentanyl consumption following gynecologic surgery.

Effects of Patient Controlled Analgesia with Morphine after Obstetric or Gynecologic Surgery / 대한마취과학회지

Intravenous patient-controlled analgesia(PCA) is gaining wide spread popularity in management of post-operative pain maintaining an effective blood concentrations of analgesics. We studied 48 patients, ASA class I or II, undergoing obstetric or gynecologic surgery under general anesthesia. We examined postoperative pain control level, patients satisfaction and side effects associated with the use of morphine and Baxter infusor. Each patient received 0.1 mg/kg as a loading dose and 0.0125 mg/kg/hr of morphine as maintenance dose. A unit was fitted with patient control module which had a flow rate of 0.5ml/hr and lockout interval was 15 minutes. Results were as follow. Pain scores were 1.88+/-0.81(first day), 1.31+/-0.71(second day). Visual analogue scales were 4.40+/-2.06(first day), 3.40+/-1.71(second day). 41 out of 48 patients in total were satisfied but nausea, dizziness or pruritus was noted. We recommend the use of PCA with morphine after surgery to improve post-operative pain because it provides adequate pain relief and a few side effects with high patients satisfaction.