Background: Preoperative medication has a vital role in anesthesia. In this study, Gabapentin and Clonidine are evaluated in the clinical efficacy of oral premedication in reducing the postoperative pain and opioid consumption in patients undergoing gastrectomyas these medications possess anxiolytic, analgesic, and anticonvulsant properties..

Methodology: Prospective, randomized, double blind, placebo controlled study was conducted on ninety patients of ASA (American Society of Anesthesiologists)Grade I and II of age group 45–65 years, allocated to one of the three groups of thirty patients each. Group I received Tab Gabapentin 600mg mg, Group II received Clonidine 100 μg and Group III received placebo at 10:00 pm, the night before and 1 h before the surgery. Parameters including sedation scores, post operative pain, opioid consumption and various side effects were assessed.

Results: Demographic variables were comparable. The VAS pain scores at measured times were significantly lower in the gabapentin group as compared to clonidine and placebo group. The post-operative opioid consumption in Gabapentin group was significantly less than Clonidine and placebo groups. There was no significant difference between the groups regarding the postoperative complications. Number of patients required > one dose of rescue analgesic were highest in the placebo group as compared to group I and group II.

Conclusion: Our study concluded that administration of 1200mg of gabapentin or 200μg clonidine preoperatively significantly reduces VAS score and opioid consumption when compared to placebo in patients undergoing gastrectomy. Also Gabapentin was more effective than clonidine in reducing postoperative pain and morphine use for analgesia.

Keywords: Gabapentin; Clonidine; Postoperative VAS; Gastrectomy; Analgesia.

1. Barr J, Zomorodi K, Bertaccini E, Shafer S, Geller E (2013) A Double-blind, Randomized Comparison of IV Lorazepam versus Midazolam for Sedation of ICU Patients via a Pharmacologic Model. Anesthesiology 95(2): 286-298
2. Miller R. Miller's (2009) anesthesia. (7th edn), PA: Churchill Livingstone/Elsevier, Philadelphia, pp: 2758-2759
3. Mesoli, Govegoankar (2003) Post-Op Pain Relief for Ambulatory Surgery. Indian Medical Gazette 138-150.
4. Pyati S, Gan TJ (2007) Perioperative pain management. CNS Drugs 21(3): 185-211.
5. Wewers M, Lowe N (1990) a critical review of visual analogue scales in the measurement of clinical phenomena. Research in nursing & health 13 (4): 227-236.
6. Gabriel J, Gordin V (2001) Alpha agonists in regional anesthesia and analgesia. Current Opinion in Anesthesiology 14 (6): 751-755.
7. Hidalgo MP, Auzani JA, Rumpel LC, Moreira NL Jr, Cursino AW, et al. (2005) The clinical effect of small oral clonidine doses on perioperative outcomes in patients undergoing abdominal hysterectomy. Anesthesia Analgesia 100(3): 795-780.
8. Goyagi T, Tanaka M, Nishikawa T (1999) Oral clonidine premedication enhances postoperative analgesia by epidural morphine. Anesthesia Analgesia 89(6): 1487-1491.
9. Barash P, Cullen B, Stoelting R (2009) Clinical anesthesia. (6th edn), Lippincott Williams & Wilkins, Philadelphia, pp: 1487(6).
10. Rose M, Kam P (2002) Gabapentin: pharmacology and its use in pain management. Anaesthesia 57 (5): 451- 462.
11. Rosenberg JM, Harrell C, Ristic H, Werner RA, de Rosayro AM (1997) The effect of gabapentin on neuropathic pain. Clinical Journal of Pain 13(3): 251-255.
12. Gilron I, Orr E, Tu D, O'Neill JP, Zamora JE, et al. (2005) A placebo-controlled randomized clinical trial of perioperative administration of gabapentin, rofecoxib and their combination for spontaneous and movement-evoked pain after abdominal hysterectomy. Pain 113(1-2): 191-200.
13. Durmus M, Kadir But A, Saricicek V, IlksenToprak H, Ozcan Ersoy M (2007) The post-operative analgesic effects of a combination of gabapentin and paracetamol in patients undergoing abdominal hysterectomy: a randomized clinical trial. Acta anaesthesiologica scandinavica 51 (3): 299-304.
14. Saraswat V, Arora V, Others (2008) Preemptive gabapentin vspregabalin for acute postoperative pain after surgery under spinal Anaesthesia. Indian Journal of Anaesthesia 52 (6): 829.
15. Pandey CK, Sahay S, Gupta D, Ambesh SP, Singh RB, et al. (2004) Preemptive gabapentin decreases postoperative pain after lumbar discoidectomy. Canadian journal of anaesthesia 51(10): 986-989.
16. Ménigaux C, Adam F, Guignard B, Sessler DI, Chauvin M (2005) Preoperative gabapentin decreases anxiety and improves early functional recovery from knee surgery. Anesthesia Analgesia 100(5): 1394-1399.
17. Dierking G, Duedahl TH, Rasmussen ML, Fomsgaard JS, Møiniche S, et al. (2004) Effects of gabapentin on postoperative morphine consumption and pain after abdominal hysterectomy: a randomized, double-blind trial. Acta anaesthesiologica scandinavica 48 (3): 322-327.
18. Turan A, Karamanlioğlu B, Memiş D, Hamamcioglu MK, Tükenmez B, et al. (2004) Analgesic effects of gabapentin after spinal surgery. Anesthesiology 100(4): 935-938.
19. Rorarius M, Menn, Er S, Suominen P, Rintala S, Puura A, et al. (2004) Gabapentin for the prevention of postoperative pain after vaginal hysterectomy. Pain 110 (1): 175-181.
20. Soltanzadeh M, Ebad A, Pipelzadeh M, Tabatabaei S, Firouzabadi M, et al. (2011) Gabapentin May Relieve Post-Coronary Artery Bypass Graft Pain: A Double Blind Randomized Clinical Trial. Iranian Cardiovascular Research Journal 5 (3): 79-82.
21. Fassoulaki A, Triga A, Melemeni A, Sarantopoulos C (2005) Multimodal analgesia with gabapentin and local anesthetics prevents acute and chronic pain after breast surgery for cancer. Anesthesia Analgesia 101(5): 1427-1432.
22. Türe H, Sayin M, Karlikaya G, Bingol CA, Aykac B, et al. (2009) The analgesic effect of gabapentin as a prophylactic anticonvulsant drug on post craniotomy pain: a prospective randomized study. Anesthesia Analgesia 109(5): 1625-1631.
23. Benhamou D, Narchi P, Hamza J, Marx M, Peyrol M, et al. (1994) Addition of oral clonidine to postoperative patient-controlled analgesia with iv morphine. British journal of anaesthesia 72 (5): 537-540.
24. Yoshikawa T, Wajima Z, Ogura A, Inoue T, Ogawa R (2001) Orally administered clonidine significantly reduces pain during injection of propofol. British journal of anaesthesia 86 (6): 874-876.
25. Mohammadi SS, Seyedi M (2008) Effects of gabapentin on early postoperative pain, nausea and vomiting in laparoscopic surgery for assisted reproductive technologies. Pakistani Journal of Biological Sciences 11(14): 1878-1880.
26. Barash P, Cullen B, Stoelting R (2009) Clinical anesthesia. (6th edn), Lippincott Williams & Wilkins, Philadelphia, pp: 1486.
27. Kehlet H, Dahl JB (2003) Anaesthesia, surgery, and challenges in postoperative recovery. Lancet 362(9399): 1921-1928.
28. Marashi S, Morabi A, Ghafari M, Azimaraghi O, Movafegh A (2012) The Effect of Pre-operative Oral Clonidine or Gabapentin on Post-operative Pain intensity, Morphine Consumption and Post-operative Nausea and Vomiting in Patients Who Undergone Thyroidectomy: A Double-blind Placebo-control Study. Journal of Anesthesia & Clinical Research 3 (4): 206.
29. Singh S, Arora K (2011) Effect of oral clonidine premedication on perioperative haemodynamic response and postoperative analgesic requirement for patients undergoing laparoscopic cholecystectomy. Indian Journal of Anaesthesia 55(1): 26-30.
30. Sung C, Lin S, Chan K, Chang W, Chow L, et al. (2000) Effect of oral clonidine premedication on perioperative hemodynamic response and postoperative analgesic requirement for patients undergoing laparoscopic cholecystectomy. Actaanaesthesiologica Sinica 38 (1): 23-29.

Irfan Andleeb Gul

Senior Resident, Department of Orthopaedics, Govt. Medical College, Srinagar, India