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Department of Anesthesiology; Mayo Clinic College of Medicine; Jacksonville, FL; harrison.barry{at}mayo.edu
To the Editor:
Given the popular use of gabapentin in the perioperative period, Adam et al. (1) are to be congratulated for their randomized, placebo-controlled study evaluating efficacy of a single-dose of gabapentin (800 mg) for arthroscopic shoulder surgery in the ambulatory setting.
In reviewing the methodology given the variable absorption rate of gabapentin, its half-life of approximately 6.5 h, and the fact that it was given 2 h before surgery, could the authors inform readers of the duration between the administration of the drug and the first patient assessment (2). In the discussion the authors state that doses as small as 300 mg have demonstrated efficacy, while in one study doses greater than 600 mg did not demonstrate efficacy, and finally in the literature doses up to 1200 mg have demonstrated efficacy (3). What was the rationale of the authors choosing a dose of 800 mg?
Although the entry criteria into the study was a successful interscalene brachial plexus block as judged by the absence of sensation to cold in the distribution of the circumflex and musculocutaneous nerves, postoperatively, seven patients (11.6%) were excluded because they required IV morphine and were found not to have a demonstrable block of the musculocutaneous nerve. How do the authors explain the discrepancy between a successful block pre surgery versus a failed block post surgery? If patients were analyzed on intention to treat analysis, are the results different?
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