Preoperative use of gabapentin for pain reduction in open surgeries under local anesthesia for idiopathic bilateral carpal tunnel syndrome

Authors

DOI:

https://doi.org/10.33448/rsd-v10i4.14506

Keywords:

Carpal Tunnel Syndrome; Preoperative Period; Adjuvants, Anesthesia; Gabapentin.

Abstract

This article aims to evaluate the preoperative use of gabapentin in the control of intra- and postoperative pain in patients with idiopathic bilateral carpal tunnel syndrome (CTS). A prospective, randomised, double-blind study involving 45 subjects with severe CTS, 23 receiving treatment (gabapentin 600 mg) and 22 receiving placebo (control), who underwent an open surgical approach in one hand under local anaesthesia. Information related to the patients’ profile, safety of the surgical procedure, history of pain, adverse effects, numbness, and medications used were collected during the 14 days of the procedure and evaluated by Generalised Estimated Equations and Generalised Linear Mixed Models. The treatment and control groups were homogeneous regarding the patients’ profile and surgical procedure data. The patients who used gabapentin 600 mg had a better evaluation during surgery (d = 0.655), anaesthesia (d = 0.854), and on the first night of sleep (d = 1.323), and they reported a higher degree of satisfaction with the surgery after 14 days (d = 1.091). The treatment group reported decreased pain in the operated hand in a 24-hour period (r = 0.34, 95% CI: 0.223–0.457) and in the 14-day follow-up period (r = 0.412, 95% CI: 0.217–0.608). These results were not impacted by the medications used and remained consistent over time. The use of a single dose of gabapentin 600 mg in the preoperative period proved to be safe and effective in reducing postoperative pain, and the improvement was noticed by the patient.

Author Biographies

Sergio Murilo Georgeto, University of Northern Paraná

Graduate Programme in Rehabilitation Sciences

Department of Neurosurgery, Santa Casa de Londrina, Londrina, PR, Brazil.

 

Rodrigo Antônio Carvalho Andraus, University of Northern Paraná

Graduate Programme in Rehabilitation Sciences

Ovídia Ignês Pires, University of Northern Paraná

Graduate Programme in Rehabilitation Sciences

Eros de Oliveira Junior, University of Northern Paraná

Group of Studies and Research in Physical Exercise and Rehabilitation (GEPEFIR)

Karen Barros Parron Fernandes, University of Northern Paraná

Graduate Programme in Rehabilitation Sciences

Institute of Education, Research ad Innovation of Imandade da Santa Casa de Londrina (IEPI-ISCAL)

References

Adams, E. H., Breiner, S., Cicero, T. J., Geller, A., Inciardi, J. A., Schnoll, S. H., Senay, E. C., & Woody, G. E. (2006). A comparison of the abuse liability of tramadol, NSAIDs, and hydrocodone in patients with chronic pain. Journal of pain and symptom management, 31(5), 465-476.

Alam, A., Gomes, T., Zheng, H., Mamdani, M. M., Juurlink, D. N., & Bell, C. M. (2012). Long-term analgesic use after low-risk surgery: a retrospective cohort study. Archives of internal medicine, 172(5), 425-430.

Arumugam, S., Lau, C. S., & Chamberlain, R. S. (2016). Use of preoperative gabapentin significantly reduces postoperative opioid consumption: a meta-analysis. Journal of pain research, 9, 631.

Atroshi, I., Hofer, M., Larsson, G.-U., Ornstein, E., Johnsson, R., & Ranstam, J. (2009). Open compared with 2-portal endoscopic carpal tunnel release: a 5-year follow-up of a randomized controlled trial. The Journal of hand surgery, 34(2), 266-272. http://www.jhandsurg.org/article/S0363-5023(08)00957-X/abstract

Bland, J. D. P. (2000). The value of the history in the diagnosis of carpal tunnel syndrome. The Journal of Hand Surgery: British & European Volume, 25(5), 445-450. https://doi.org/https://doi.org/10.1054/jhsb.2000.0452

Bot, A. G., Bekkers, S., Arnstein, P. M., Smith, R. M., & Ring, D. (2014). Opioid use after fracture surgery correlates with pain intensity and satisfaction with pain relief. Clinical Orthopaedics and Related Research®, 472(8), 2542-2549.

Bowman, A., Rudolfer, S., Weller, P., & Bland, J. D. (2018). A prognostic model for the patient‐reported outcome of surgical treatment of carpal tunnel syndrome. Muscle & nerve, 58(6), 784-789.

Cha, S. M., Shin, H. D., Ahn, J. S., Beom, J. W., & Kim, D. Y. (2016). Differences in the postoperative outcomes according to the primary treatment options chosen by patients with carpal tunnel syndrome: conservative versus operative treatment. Ann Plast Surg, 77(1), 80-84.

Chaparro, L. E., Smith, S. A., Moore, R. A., Wiffen, P. J., & Gilron, I. (2013). Pharmacotherapy for the prevention of chronic pain after surgery in adults. Cochrane Database of Systematic Reviews(7).

Chapman, T. K., N.: Maltenfort, M.: Ilyas, A. M. (2017). Prospective Evaluation of Opioid Consumption Following Carpal Tunnel Release Surgery. Hand (N Y), 12(1), 39-42. https://doi.org/10.1177/1558944716646765

Cohen, J. (2013). Statistical power analysis for the behavioral sciences. Academic press.

Crisologo, P. A., Monson, E. K., & Atway, S. A. (2018). Gabapentin as an adjunct to standard postoperative pain management protocol in lower extremity surgery. The Journal of Foot and Ankle Surgery, 57(4), 781-784.

Dec, P., & Zyluk, A. (2018). Bilateral carpal tunnel syndrome - A review. Neurol Neurochir Pol, 52(1), 79-83. https://doi.org/10.1016/j.pjnns.2017.09.009

Delgado, D. A., Lambert, B. S., Boutris, N., McCulloch, P. C., Robbins, A. B., Moreno, M. R., & Harris, J. D. (2018). Validation of digital visual analog scale pain scoring with a traditional paper-based visual analog scale in adults. Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews, 2(3).

Doyle, D. J., & Garmon, E. H. (2019). American Society of Anesthesiologists classification (ASA class). In StatPearls [Internet]. StatPearls Publishing.

Farhangkhoee, H., Lalonde, J., & Lalonde, D. H. (2012). Teaching medical students and residents how to inject local anesthesia almost painlessly. Canadian Journal of Plastic Surgery, 20(3), 169-172.

Galbiatti, J. A., Komatsu, S., Faloppa, F., Albertoni, W. M., & Silva, S. E. A. B. d. (1991). Via de acesso ulnal na síndrome do túnel do carpo. Rev. bras. ortop, 389-394.

Harden, R. N., Bruehl, S., Perez, R. S., Birklein, F., Marinus, J., Maihofner, C., Lubenow, T., Buvanendran, A., Mackey, S., & Graciosa, J. (2010). Validation of proposed diagnostic criteria (the “Budapest Criteria”) for complex regional pain syndrome. Pain, 150(2), 268-274.

Hattie, J. (2012). Visible learning for teachers: Maximizing impact on learning. Routledge.

Hjermstad, M. J., Fayers, P. M., Haugen, D. F., Caraceni, A., Hanks, G. W., Loge, J. H., Fainsinger, R., Aass, N., Kaasa, S., & Collaborative, E. P. C. R. (2011). Studies comparing Numerical Rating Scales, Verbal Rating Scales, and Visual Analogue Scales for assessment of pain intensity in adults: a systematic literature review. Journal of pain and symptom management, 41(6), 1073-1093.

Jablecki, C. A., MT: Floeter, MK: Miller, RG: Quartly, CA: Vennix, MJ: Wilson, JR. (2002). Practice parameter: Electrodiagnostic studies in carpal tunnel syndrome Report of the American Association of Electrodiagnostic Medicine, American Academy of Neurology, and the American Academy of Physical Medicine and Rehabilitation. Neurology, 58(11), 1589-1592.

Katz, J., Clarke, H., & Seltzer, Z. e. (2011). Preventive analgesia: quo vadimus? Anesthesia & Analgesia, 113(5), 1242-1253.

Lalonde, D. H. (2010). “Hole-in-one” local anesthesia for wide-awake carpal tunnel surgery. Plastic and reconstructive surgery, 126(5), 1642-1644.

Lalonde, D. H. (2019). Latest advances in wide awake hand surgery. Hand Clin, 35(1), 1-6.

Larsen, M. B., Sorensen, A. I., Crone, K. L., Weis, T., & Boeckstyns, M. E. (2013). Carpal tunnel release: a randomized comparison of three surgical methods. J Hand Surg Eur Vol, 38(6), 646-650. https://doi.org/10.1177/1753193412475247

Magalhães, M. J. d. S. d., Fernandes, J. L. S., Alkmim, M. S., & Anjos, E. B. d. (2017). Epidemiology and Estimated Cost of Surgeries for Carpal Tunnel Syndrome Conducted by the Unified Health System in Brazil (2008–2016). Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery, 38(02), 086-093. https://doi.org/10.1055/s-0037-1604039

Miller, A., Kim, N., Zmistowski, B., Ilyas, A. M., & Matzon, J. L. (2017). Postoperative pain management following carpal tunnel release: a prospective cohort evaluation. Hand, 12(6), 541-545.

Milone, M. T., Karim, A., Klifto, C. S., & Capo, J. T. (2019). Analysis of Expected Costs of Carpal Tunnel Syndrome Treatment Strategies. Hand (N Y), 14(3), 317-323. https://doi.org/10.1177/1558944717743597

Padua, L., Pasqualetti, P., & Rosenbaum, R. (2005). One patient, two carpal tunnels: statistical and clinical analysis—by hand or by patient? Clinical Neurophysiology, 2(116), 241-243.

Page, P. (2014). Beyond statistical significance: clinical interpretation of rehabilitation research literature. International journal of sports physical therapy, 9(5), 726.

Phillips, A., Jagodzinski, N., & Lalond Donald, H. (2016). What is wide-awake hand surgery. General principles of wide-awake hand surgery. New Brunswick: CRC Pr ess, 17-22.

Sadatsune, E. J., Leal, P. d. C., Cossetti, R. J. D., & Sakata, R. K. (2016). Effect of preoperative gabapentin on pain intensity and development of chronic pain after carpal tunnel syndrome surgical treatment in women: randomized, double-blind, placebo-controlled study. Sao Paulo medical journal, 134(4), 285-291.

Sonoo, M., Menkes, D. L., Bland, J. D. P., & Burke, D. (2018). Nerve conduction studies and EMG in carpal tunnel syndrome: Do they add value? Clin Neurophysiol Pract, 3, 78-88. https://doi.org/10.1016/j.cnp.2018.02.005

Srivastava, U., Kumar, A., Saxena, S., Mishra, A. R., Saraswat, N., & Mishra, S. (2010). Effect of preoperative gabapentin on postoperative pain and tramadol consumption after minilap open cholecystectomy: a randomized double-blind, placebo-controlled trial. European Journal of Anaesthesiology (EJA), 27(4), 331-335.

Tubiana, R. (1990). Carpal tunnel syndrome : some views on its management. Annales de Chirurgie de la Main et du Membre Supérieur, 9(5), 325-330. https://doi.org/https://doi.org/10.1016/S0753-9053(05)80505-8

Unno, F., Lucchina, S., Bosson, D., & Fusetti, C. (2015). Immediate and durable clinical improvement in the non-operated hand after contralateral surgery for patients with bilateral Carpal Tunnel Syndrome. Hand (N Y), 10(3), 381-387. https://doi.org/10.1007/s11552-014-9719-6

Vasiliadis, H. S., Georgoulas, P., Shrier, I., Salanti, G., & Scholten, R. J. (2014). Endoscopic release for carpal tunnel syndrome. Cochrane Database of Systematic Reviews(1).

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Published

22/04/2021

How to Cite

GEORGETO, S. M.; ANDRAUS, R. A. C.; PIRES, O. I.; OLIVEIRA JUNIOR, E. de; FERNANDES, K. B. P. Preoperative use of gabapentin for pain reduction in open surgeries under local anesthesia for idiopathic bilateral carpal tunnel syndrome. Research, Society and Development, [S. l.], v. 10, n. 4, p. e54410414506, 2021. DOI: 10.33448/rsd-v10i4.14506. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/14506. Acesso em: 16 may. 2021.

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Health Sciences