بسم الله الرحمن الرحیم

1. بسم الله الرحمن الرحیم

2. Mohsen Mardani-Kivi, M.D. Associate Professor Guilan University Of Medical Sciences

3. Background • pre-emptive analgesianot only controls pain but also may result in the reduction of opioid consumption and related side effects following orthopedic surgeries.

4. Background • Gabapentin: • an anti-epileptic drug • inhibits the release of nociceptive neurotransmitters including P-substance and norepinephrine from presynaptic afferent neurons

5. The purpose of the study • To examine the effects of Gabapentinin reducing pain following the ArthroscopicBankartsurgery

7. Methods and Materials:

8. Flowchart of the study

9. Results • There were nosignificant differences between the demographic characteristics (age, gender and BMI), the operation duration time and pain intensity between the two groups prior to the study (all P>0.05)

10. Results: • Pain intensity • At both 6hr and 24hr visits the pain intensity were not significantly different between the two groups.

11. Results: Opioid consumption • Although the pain intensity was similar between G and P groups, the opioid consumption was significantly lower in G group both at 6hr and 24hr visits.

12. Results: Opioid consumption

13. Results: adverse effects • Dizziness was similar in G and P groups both at 6hr and at 24hr follow-up visits. • Nausea and vomiting were significantly lower in G group at 6hr follow-up visit (p=0.001), however, at 24h follow-up visit, the difference between G and P groups was not significant (p>0.05).

14. Discussion • Pandey et al. • The effectiveness of gabapentin administered at: • 600mg is more than 300mg • 600mg is as the same as 900 or 1200mg

15. Discussion • A systematic review of 1151 patients by Ho et al. • 614 patients in 16 RCTs • divided the studies into three categories: • A) a single dose of 1200mg • B) a single dose less than 1200mg • C) multiple dose of less than 1200mg

16. Discussion • A systematic review of 1151 patients by Ho et al. • 614 patients in 16 RCTs • In all three categories, the opioid consumption was significantly reduced postoperatively. • In all three categories, patients in gabapentin group experienced significantly less vomiting and pruritus.

17. Discussion • The dosage higher than 600mg of gabapentin does not necessarily lead to additional analgesic benefit or additional decrease in opioid consumption. • However, the repeated multi-doses of gabapentin will result in an increase in side effects especially sedation.

18. Discussion

19. Gabapentin Advantages • Since the maximum plasma concentration occur 2-3h after the ingestion, it is recommended to administer gabapentin two hours preoperatively to have maximal plasma concentration peak during the operation

20. Gabapentin Advantages • Since gabapentin has no hepatic metabolism, is excreted without change through the kidneys with first order kinetic mechanism and has no special medicinal intervention, it can be used in different surgical interventions.

21. Conclusion • Administration of gabapentin 600 mg 2h prior to arthroscopic bankart surgery may reduce opioid consumption and its side effects (PONV)

22. Any suggestions?