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New SDN Article: “The Boards”: USMLE Overview
In residency, we used Lyrica in holding for multimodal pain management in the setting of regional anesthesia. Lyrica, Celebrex, sometimes Decadron, along with the PNC. Our regional guru swore that that combination augmented the block.
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Yes, been using it on patients that we do the post-op pain management on--epidurals, intrathecal/epidural morphine. Does in fact seem to cut down on breakthrough pain and requirements (& phone calls) for supplemental meds. 
Use it. Not convinced. I think the observed positive results are mostly related to the sedation side-effects. We give 1200mg pre-op. I'd sleep for 2 days if you gave me, a gabapentin naive person, that much Neurontin.
-copro
-copro
OP
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Very interesting. Do you keep giving it? Or, is it a one time deal as copro is doing?Does in fact seem to cut down on breakthrough pain and requirements (& phone calls) for supplemental meds.
Sedation, as copro said, seems to be a huge side effect. I wonder if people are using it because of that.
Has anyone noticed any difference while under GA? Less narcotic need? Faster, slower wake up? Does it affect the BIS? Does it affect the MAC? Less bucking? What about PACU discharge time?
Almost all these issues (less narcotic, less bucking) have some literature to support its use. Most of the literature I have read use it as a single preop dose of 800mg-1200mg.
Here is a good review, but a pubmed search ("preoperative gabapentin") shows many articles on the subject.
Gabapentin and postoperative pain--a systematic review of randomized controlled trials.
Pain. 2006 Dec 15;126(1-3):91-101. 2006 Jul 18. Review.
The data on Celebrex is similar. For TKA's we use celebrex 400mg, gabapentin 900mg, and I think some tylenol, and a fascia iliaca catheter.
Nice cocktail, but why fascia iliaca catheter versus femoral nerve catheter?
I have seen some promising literature about using Pregabalin (Lyrica) for acute post op pain any one is using it?
I think recent info showed a ceiling effect at 600 mg with only increased side effects above that. No wonder you're seeing so much sedation.
We just give the one pre-op dose since that covers the time we usually follow the patients for Duramorph & most of our epidurals only run 24 hrs. The surgeons haven't indicated any interest in continuing it when they take over the pain management.
following the methods of the studies i have been SERIOUSLY burnt by 1200mg of Neurontin pre-operatively - i have had some major unresponsive patients with the required CT head/Neuro consult, and then have to wait 3 days for their brains to clear before going to the OR...
- Aug 8, 2001
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We used to give up to 1200 of gaba but don't anymore because a couple of people didn't want to wake up. think they went to the ICU for a while afterwards as well.
Dose is based on some of recommendations coming out of Tim Brennan's work at University of Iowa.
-copro
I'm not sure. No reason really.
This makes more sense to me since pregabalin works much quicker than gabapentin (1 week vs 1 month), so one would think that a single dose a pregabalin would be more effective.
- Apr 16, 2006
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hey urge
actually this new multimodal therapy is becoming somewhat of a standard, or will be.
look at studies by Reuben. he uses celebrex 400 mg preop an hour before the sx. then he gives it to the pts 200mg q 12 x 10 days. seen good opiod sparing results. same with the alpha 2 delta guys (neurontin/pregablin).
- Aug 8, 2001
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