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ANALGESIA

A Randomized, Double-Blind, Controlled Trial of Perioperative Administration of Gabapentin, Meloxicam and Their Combination for Spontaneous and Movement-Evoked Pain After Ambulatory Laparoscopic Cholecystectomy

Ian Gilron, MD, MSc, FRCPC^*, Elizabeth Orr, RN^*, Dongsheng Tu, PhD, C. Dale Mercer, MD, FRCSC, and David Bond, MB, BChir, MA, MSc, CCFP, FRCPC^||

From the *Department of Anesthesiology, Kingston General Hospital, and the Departments of Pharmacology and Toxicology, Mathematics and Statistics, and Surgery, Queen's University, Kingston, Ontario, Canada; and ||Department of Anesthesiology, University of British Columbia, Vancouver, British Columbia, Canada.

Address correspondence and reprint requests to Ian Gilron, MD, MSc, FRCP(C), Department of Anesthesiology, Victory 2 Pavillion, Queen's University, c/o Kingston General Hospital, 76 Stuart St., Kingston, ON, Canada K7L 2V7. Address e-mail to gilroni{at}post.queensu.ca.

Abstract

BACKGROUND: Hysterectomy and spinal surgery inpatient trials suggest favorable interactions between cyclooxgenase-2 inhibitors and gabapentin/pregabalin on postoperative days 1–2. We present the first trial of meloxicam-gabapentin combination after outpatient laparoscopic cholecystectomy.

METHODS: This was a randomized, double-blind trial comparing daily oral administration of 1) meloxicam 15 mg, 2) gabapentin 1200–1600 mg, and 3) a combination of the two starting 1 h before until 2 days after surgery. Primary outcomes included day of surgery spontaneous and movement-evoked pain. Secondary outcomes included pain on Days 1, 2, and 30, adverse effects, opioid consumption, spirometry, pain-related interference, hospital discharge time, return to work time, and patient satisfaction.

RESULTS: On the day of surgery, 60-min rest pain (0–10 numerical rating scale ± sd) was significantly lower (P < 0.05) with gabapentin alone (2.0 ± 1.6) versus meloxicam alone (3.6 ± 2.1). Observed pain differences between the combination (2.9 ± 2.1) and gabapentin alone were fairly small in favor of gabapentin alone (P > 0.05). Secondary analyses indicated that nausea was significantly less frequent with the combination (24%) versus the single-drug meloxicam (57%) only.

CONCLUSION: Although nausea was reduced with combination therapy, this trial provides little or no support for the combined use of meloxicam and gabapentin for pain relief on the day of surgery. This suggests that perioperative analgesic polypharmacy may not always be necessary or appropriate.