EFICACIA DE USO DE LA GABAPENTINA EN EL CONTROL DEL DOLOR, NÁUSEA Y VÓMITO EN EL POSTOPERATORIO DE LA FUNDUPLICATURA LAPAROSCOPICA TIPO NISSEN

Abstract

INTRODUCTION Laparoscopic antireflux surgery provides relief in up to 90% of cases and prevents the occurrence of disease complications gastro-esophageal reflux. Minimally invasive surgery allows for a procedure with less tissue damage, better exposure of anatomical structures and shorter surgical and anesthetic time: still may occur in the immediate postoperative unpleasant effects, the most common are pain, nausea and vomiting that impact directly on patient outcomes, incidence of complications (migration of the fundoplication, perforation, bleeding) with the consequent increase in hospital stay and medical care costs (medications, re-interventions, treatments, etc.). OBJECTIVES Determine whether the preoperative use of gabapentin reduces the incidence of postoperative pain, nausea and vomiting in patients undergoing laparoscopic fundoplication MATERIAL AND METHODS We conducted a clinical trial in patients with indications for laparoscopic antireflux surgery with Nissen technique. Two groups: the first group was administered three doses of 300 mg of Gabapentin every 8 hours, beginning one hour before surgery, the second group received placebo at identical times. The sample size was performed with the formula for comparison of 2 means, 18 patients were calculated for each group. RESULTS We studied 34 patients in total, of which 18 were men (53%) and 16 women (47%) with mean age of 48.12 years. Group 1 (Gabapentin) comply with 18 patients and group 2 (placebo or control) with 16 patients, both groups are homogeneous. There`s significant evidence to establish that gabapentina controls pain (p=0.0001), nausea (p=0.0001) and vomiting (p=0.002) in the postoperative period of laparoscopic Nissen fundoplication. V XII In G1 postoperative ambulation (p=0.0001) was earlier; the hospital stay (p=0.0001) and dysphagia was lower in this group (gabapentin 16.7% vs 68.8% Control). Rescue analgesia and ondansetron rescue was also significantly lower in G1. CONCLUSIONS Taking into account the parameters of mild pain, no nausea and vomiting, we can establish that gabapentin is an effective medication (84.6% vs 8.3%) at doses of 300 mg every 8 hours (total 900 mg) administration beginning 1 hour before surgery and then at 8 and 16 hours after laparoscopic Nissen fundoplication. The use of gabapentin reduces postoperative pain sensation keeping it in low levels (1-3 in visual scale of pain) compared with the sensation of moderate pain in the control group (3.1 to 6 in VAS). It also decreases the incidence of nausea and vomiting in the immediate postoperative period following such surgery.