Efficacy of Gabapentin on combined spinal epidural anesthesia for lower limb orthopedic surgeries

Background: Orthopedic patients can be particularly challenging for anesthesiologists. Many orthopedic procedures are well suited for regional anesthetic techniques. Epidural analgesia is the one method which can be performed easily, can provide intra-operative and postoperative analgesia better than other methods with better patient comfort. Aim: To study the efficacy of Gabapentin on combined spinal epidural anesthesia for lower limb orthopedic surgeries with respect to postoperative epidural analgesic requirements. Materials and methods: This study involved, using Gabapentin and the effects of it on combined spinal epidural anesthesia in respective of postoperative epidural analgesic requirements. 60 patients of ASA I, II undergoing lower limb surgeries were randomly assigned into two groups Group G, and Group P. Surgery was done under combined spinal epidural anesthesia. The patients' in-group G received three Gabapentin capsules (1200 mg). In-group P, three placebo capsules were given. Subarachnoid block was performed with 0.5% Bupivacaine 3 ml (Hyper baric). Epidural analgesia was given by 0.125%bupivacaine with Fentanyl 2 µg/ml (8 ml volume). Results: The parameters observed were the mean time to regress by two segments from higher level of blockade (90.7 ± 4.7 minutes (G) VS 85.8 ± 3.5 minutes (P), p <0.05), the time to require first epidural analgesic supplementation (228.5 ± 19.96 minutes (G) VS 195.5 ±13.3minutes (P), p <0.05), the time interval between the epidural analgesic supplementations (8.25 ±1.5 hours (G) VS 4.8± 0.5 hours (P), p <0.05), the total number of epidural requirements in first 24 hours (2 ± 0.2 (G) VS 2.93 ± 0.2(P), p<0.05) , and in the next 24 hours (3 (G) VS 4 (P) , p<0.05). Conclusion: This provides an evidence of the Gabapentin before surgery significantly prolongs two-segment regression time and duration of analgesia in subarachnoid blockade and it significantly reduces the postoperative epidural analgesia requirements.