Gabapentin does not reduce post-thoracotomy shoulder pain: a randomized, double-blind placebo-controlled study

Area of Science:

• Anesthesiology
• Pain Management
• Thoracic Surgery

Background:

• Post-thoracotomy shoulder pain affects up to 97% of patients, even with adequate epidural analgesia.
• Ipsilateral shoulder pain is a common and persistent issue following thoracotomy procedures.

Purpose of the Study:

• To evaluate the safety and efficacy of pre-emptive gabapentin in managing post-thoracotomy shoulder pain.
• To determine if a 1200 mg dose of gabapentin administered pre-operatively impacts shoulder pain and analgesic requirements.

Main Methods:

• A double-blind, placebo-controlled study involving 51 patients undergoing thoracotomy.
• Patients received either 1200 mg gabapentin or placebo two hours before surgery.
• Pain was monitored using a numerical rating scale, with hydromorphone for rescue analgesia.

Main Results:

• Shoulder pain prevalence was 86%, with no significant difference in pain scores or hydromorphone use between gabapentin and placebo groups.
• No significant differences were observed in surgical site pain between the groups.
• Increased sedation was noted at 4 hours in the gabapentin group, but this resolved by 24 hours.

Conclusions:

• Pre-emptive administration of 1200 mg gabapentin is ineffective in reducing the incidence or severity of post-thoracotomy shoulder pain.
• Gabapentin did not improve analgesic outcomes for shoulder pain in patients receiving thoracic epidural analgesia.
• While initial sedation was higher, gabapentin did not significantly alter overall side effect profiles by 24 hours.