Postoperative Analgesic Consumption After Preoperative Gabapentin vs Placebo in Breast Cancer Surgery

Comparison of Mean Analgesia Consumption for Postoperative Pain With Single Dose of Preoperative Oral Gabapentin Versus Placebo in Patients Undergoing Breast Cancer Surgery

The study will be conducted after approval from the Scientific and Ethical Review Committees. Eligible patients will be enrolled after obtaining written informed consent and randomly allocated to Group A (gabapentin) or Group B (placebo). Group A will receive oral gabapentin 600 mg one hour before surgery, while Group B will receive oral placebo (sodium bicarbonate) at the same time.

General anesthesia will be induced with propofol, atracurium, and fentanyl and maintained with sevoflurane using a supraglottic airway device. Both groups will receive IV paracetamol, ketorolac, and local bupivacaine infiltration. Intraoperative rescue analgesia with IV morphine will be given if hemodynamic parameters increase by >20% from baseline.

Postoperatively, patients will be monitored in the recovery area for pain using the Numeric Rating Scale (NRS) and for adverse effects including drowsiness, nausea, and vomiting. IV morphine 0.1 mg/kg will be administered if the NRS pain score is >2. The total morphine consumption during recovery will be recorded for both groups. Data will be collected using the attached proforma.

This study will be carried out after approval from scientific and ethical review committee. Patient who fulfill the criteria will be enrolled in this study. Written and informed consent will be taken from study participants. Patients will be randomly allocated (as mentioned above) either in to group A (Gabapentin) or group B (placebo). Patients in Group A will be given oral gabapentin 600 mg10 one hour before surgery while patients in group B will be given oral placebo (Tablet sodium bicarbonate) one hour before surgery. . Induction of anesthesia will be done using propofol 1.5-2 mg/kg, atracurium 0.5 mg/kg and fentanyl 1 mcg/kg. Both group of patients will undergo general anesthesia with supra glottic airway device. Anesthesia will be maintained using sevoflurane using MAC 0.8-1.0. Both group of patients will receive intravenous paracetamol 1 gram, ketorolac 30 mg and local infiltration (bupivacaine) upto 2mg/kg. Intravenous morphine (0.1 mg/kg) will be administered intra operatively as rescue analgesia if blood pressure or/and heart rate increases 20 % above baseline. Ondansetron IV, 4 mg, was administered 30 minutes before to the conclusion of operation. After surgery patients will be transferred to recovery area. Patients will be monitored for pain score for a period of their whole stay in recovery area using numeric rating scale. The post-anesthesia care unit was transferred with the patients. In recovery area, adverse effects such pain, drowsiness, nausea, vomiting, and others were monitored. If the pain is score is greater than 2, then intra venous morphine 0.1 mg/kg will be administered as a bolus. Therefore in both group of patients total morphine used for each patient during their stay in recovery will be noted. Data will be collected on Performa attached at the end.

Inclusion Criteria:

1. Age between 18 to 60 years.
2. Female Gender
3. American Society of Anesthesiologists grade 1 and 2 patients.
4. Elective breast surgery
5. Admitted and day case surgeries

Exclusion Criteria:

1. Patients allergic to gabapentin
2. Patients refusal.
3. Patients having a history of chronic pain.
4. Patients already using opioids for pain control