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The effect of a preoperative single dose of gabapentin on emergence agitation in patients undergoing rhinoplasty: a randomized clinical trial

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Abstract

Background

Emergence agitation (EA) is a common post-anesthesia condition that presents with restlessness, excitation, disorientation, and inconsolable crying. Gabapentin is a structural analog of gamma-aminobutyric acid, which is an anticonvulsant medication that also acts as an anti-hyperalgesic and anti-nociceptive drug. In the present study, we evaluated the effect of the single-dose preoperative administration of gabapentin (600 mg) on EA after rhinoplasty.

Methods

In this prospective, multicenter, double-blinded randomized controlled trial, we enrolled 120 rhinoplasty candidates from September 2019 to September 2020. Patients were randomly allocated into two groups to receive either gabapentin (600 mg) or a placebo before the operation. To assess postoperative pain, a numerical rating scale was used. Also, restlessness was evaluated based on a 7-point Riker Sedation-Agitation Scale extending from unarousable (point 1) to dangerous agitation (point 7). The patients with a median age of 31 years and a median weight of 65 kg were divided and matched based on age and weight between the two groups (receiving a single dose of gabapentin) and controls (receiving placebo).

Results

The gabapentin group demonstrated a significantly lower restlessness score, both during extubation and after recovery compared to the control group (P =0.001 and 0.001). Regarding postoperative pain, nausea, and dizziness, although these values were lower in the intervention group, there was no statistically significant difference between the two groups (P=0.462, 0.494, and 0.163, respectively).

Conclusions

Preoperative oral administration of gabapentin (600 mg) significantly reduced restlessness during recovery and extubation.

Level of evidence

Level I, therapeutic study

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Abbreviations

EA:

emergence agitation

GABA:

gamma-aminobutyric acid

ASA:

American Society of Anesthesiologists

RSAS:

Riker Sedation-Agitation Scale

NRS:

numerical rating scale

GCP:

good clinical practice

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Acknowledgements

The authors would like to thank Shiraz University of Medical Sciences, Shiraz, Iran, and also the Center for Development of Clinical Research of Nemazee Hospital and Dr. Nasrin Shokrpour for editorial assistance.

Funding

No specific funding was obtained for this study.

Author information

Authors and Affiliations

  1. Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

    Mohammad Ali Hoghoughi & Akbar Alvandi

  2. Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

    Reza Jouybar

  3. Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

    Reza Shahriarirad & Keivan Ranjbar

  4. Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran

    Reza Shahriarirad, Keivan Ranjbar & Hooman Kamran

  5. Division of Trauma, Critical Care, Burns and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA

    Hamidreza Hosseinpour

  6. Nemazee Hospital, Zand Street, Nemazee Square, Shiraz, 71936-13311, Iran

    Hooman Kamran

Authors
  1. Mohammad Ali Hoghoughi
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  2. Reza Jouybar
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Contributions

Study design: M.A.H.; data acquisition: H.H, R.J, A.A.; data analysis: R.S, M.A.H.; data interpretation: M.A.H, H.H, K.R, A.A.; manuscript preparation: H.K, R.S, K.R, M.A.H, H.H.; manuscript revision: all authors. All authors read and approved the manuscript.

Corresponding author

Correspondence to Hooman Kamran.

Ethics declarations

Ethics approval

The study was approved by the ethics committee of Shiraz University of Medical Sciences (IR.SUMS.MED.REC.1398.395), the Institutional Review Board, and the Iranian Registry of Clinical Trials (IRCT20200907048652N2) on 2/1/2021. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Consent to participate

Informed consent was obtained from all patients or their legally authorized representatives for being included in the study.

Consent for publication

Informed consent was obtained from all patients or their legally authorized representatives for the publication of the study.

Competing interests

Mohammad Ali Hoghoughi, Reza Jouybar, Akbar Alvandi, Reza Shahriarirad, Hamidreza Hosseinpour, Keivan Ranjbar, and Hooman Kamran declare no competing interests.

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Hoghoughi, M.A., Jouybar, R., Alvandi, A. et al. The effect of a preoperative single dose of gabapentin on emergence agitation in patients undergoing rhinoplasty: a randomized clinical trial. Eur J Plast Surg 46, 1019–1025 (2023). https://doi.org/10.1007/s00238-023-02116-7

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