Combination of gabapentin and celecoxib for analgesia after major orthopedic surgery : a randomized controlled trial comparing the combination and either gabapentin or celecoxib alone

Abstract

Objectives : To determine how the perioperative use of celecoxib in combination with gabapentin changes the amount of postoperative opioid consumption and pain score comparing to celecoxib alone or gabapentin alone. Setting : Ramathibodi hospital Design : Randomized double-blinded placebo controlled trial Subjects and method : The study was done in 99 patients, ASA physical status I-III, 18-80 year-old, who underwent major orthopedic surgery at Ramathibodi hospital during August 2009 and February 2010. The patients were allocated into 4 groups: 1) Placebo group (P). 2) Celecoxib group (C); received celecoxib 400 mg 1-2 hour preoperatively and 200 mg 12 and 24 hours later. 3) Gabapentin group (G); received gabapentin 400 mg preoperatively and 300 mg 12 and 24 hours later, and 4) Celecoxib + Gabapentin group (CG), received celecoxib 400 mg + gabapentin 400 mg preoperatively and celecoxib 200 mg + gabapentin 300 mg 12 and 24 hours later. After surgery under general anesthesia the patients received morphine by patient-controlled analgesia machine to relief pain. Results : Median twenty-four hour morphine consumption in P, C, G, and CG groups were 18.0 (1-63), 15.0 (2-30), 15.5 (0-37) and 8.0 (0-38) mg respectively, with significant difference. Pain score at postoperative hour 1, 4, 8, 12, 16, 20 and 24 were not different. Other complications such as sedation, nausea/vomiting, dizziness, etc, were not different. Conclusion : Combination of celecoxib and gabapentin in patients who had major orthopedic surgery further reduced 24 hour postoperative morphine consumption compared with either drug alone without change in pain score, side effects and patient satisfaction.