The Role of Gabapentin in Postoperative Pain Following Tonsillectomy

Background Despite the many different surgical techniques and medical therapies, tonsillectomy continues to cause significant discomfort to patients. The literature has shown that gabapentin has been beneficial in painful conditions such as post-herpetic neuralgia and neuropathic cancer pain, it is also effective at reducing opioid consumption and postoperative pain scores following abdominal hysterectomy and spinal surgery. There is a lack of evidence to determine the effectiveness of gabapentin in tonsillectomy. Aim To establish the role of a single dose of preoperative gabapentin in reducing morbidity following tonsillectomy. Study design This research systematically analyses the adult experience of pain following tonsillectomy, reviews the role of gabapentin in otorhinolaryngology, and reports the results of a randomised, double-blind, placebo-controlled trial designed to establish the role of a single dose of preoperative gabapentin in reducing morbidity following tonsillectomy. The trial design was chosen to provide the highest level of evidence possible in order to answer the research question. All participants were adults (16 – 65 years old) scheduled for tonsillectomy between January and October 2014. Patient-assigned pain scores were the primary outcome, with analgesic consumption, postoperative nausea and vomiting, return to diet and normal activities considered as secondary outcomes. Trial results There was an overall peak in pain intensity at postoperative Day 5, analgesic consumption was stable until Day 7, followed by a gradual decline. Preoperative gabapentin 600 mg reduced pain and analgesic consumption in the early postoperative period (< 4 hours) in comparison to placebo, however, this did not reach statistical significance. Interestingly, resting pain scores were significantly higher in the gabapentin group from Day 6 to Day 10, and analgesic consumption with paracetamol and codeine was higher in the gabapentin group when compared to placebo from Day 1 onwards. There was no significant difference between the groups for swallowing pain scores, nausea and vomiting, return to normal diet, daily activities, or work. Conclusion The early postoperative pain score in the gabapentin group correlates with much of the current literature. In this study, this benefit is negligible and outweighed by the significantly higher rest pain scores from Day 5 to Day 10 and the increased analgesic consumption in the gabapentin group compared to placebo. This is the first trial of its kind to report these findings with a 14 day follow-up period. This study does not support the use of gabapentin for routine use in tonsillectomy