Since the 1990s, the amount of prescribed opioids has begun growing. According to the
Center for Disease Control, more than 130 people die every day due to opioid overdose.
Many medical and surgical specialities have devised various methods to decrease opioid
use with adequate pain control. One notable method is preoperative administration of
gabapentin. Gabapentin, a prescribed medication, is an anticonvulsant medication used to
treat partial seizures, neuropathic pain (e.g.
diabetic neuropathy, postherpetic neuralgia, and central neuropathic pain), hot flashes,
and restless legs syndrome . Various surgical specialties such as otolaryngology,
plastics, general surgery, obstetrics/gynecology have tested the efficacy of gabapentin
in reducing postoperative opioid usage without compromising pain control and the result
is promising. However, this study has not been done in oral and maxillofacial surgery.
The objectives of the study is to determine if preoperative administration of gabapentin
can decrease intraoperative and postoperative use of opioid and provide adequate pain
control when used with non-opioid pain regimen.
On the day of consultation visit, subjects will be screened and evaluated by oral and
maxillofacial surgery residents. Those who meet the inclusion criteria will be enrolled
in the study. They will then be randomly divided into following groups:
Group 1a: 49 subjects undergoing wisdom teeth extraction will be receiving 600mg
gabapentin PO preoperatively
Group 1b: 49 subjects undergoing wisdom teeth extraction will be receiving placebo
PO preoperatively.
A subject then will be given a small bag that contains either a gabapentin pill or a
placebo pill depending on which group that he or she is assigned to. The subject will be
asked to take 600mg of gabapentin or a placebo pill 2 hours prior to their procedure (vs.
current standard of care is no pre-medication). On the day of the procedure, they will be
accompanied by a guardian or a family member to the clinic. The Procedure will be done by
a senior or a chief level resident with supervision of an attending surgeon.
Intraoperative opioid use will be recorded on a standardized anesthesia sheet. All cases
will include IV sedation that involves a concoction of fentanyl, midazolam, propofol,
ketamine, and dexamethasone. The medications will be given in boluses depending on their
weight but not necessarily strictly kg-based. For example, fentanyl will be given between
25 -50mcg, midazolam 2.5-5mg, propofol 10-40mg and ketamine 10-50mg. Local anesthesia
with 2% lidocaine with 1:100,000 epinephrine will also be given after sedation.
Additional doses of local anesthetic can be given if the patient experiences sharp pain.
Additional doses of propofol and/or fentanyl can be given if the patient's systolic blood
pressure increases by 10 mmHg or heart rate increases by 20 bpm acutely. All used
anesthetics will be recorded. After the procedure, standard postoperative pain regimen
will be prescribed including 28 tablets of ibuprofen 600mg PO q6h prn pain and 12 tablets
of Norco 5/325mg PO q6h prn pain with an instruction to take Norco only when a subject is
in severe pain (pain level greater than 7 out of 10). To assess the severity of pain and
its impact on functioning, scientists developed Brief Pain Inventory from which Modified
Brief pain inventory (MBPI) was created to better fit the need for our research; MBPI
will not only ask the severity of pain but also the number of analgesics taken and side
effect profiles (e.g. nausea/vomiting, dizziness) at the following intervals, 4 hour, 8
hour, 12 hour, 24, and 72 hour post-procedure. The patient is to turn in the MBPI form
during their 1 week postoperative follow up visit. If for any reason, the patient misses
the follow up appointment, we will try to reschedule their visit within 5 days. If the
patient does not show up at all, our members will find out the reason for the no show and
record it for the publication purpose.
