The analgesic effect of gabapentin and mexiletine after breast surgery for cancer

• Published in: Anesthesia and analgesia Vol. 95; no. 4; pp. 985 - 991
• Main Authors: FASSOULAKI, Argyro, PATRIS, Konstantinos, SARANTOPOULOS, Costantine, HOGAN, Quinn
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott 01.10.2002
• Subjects: Acetates - therapeutic use; Aged; Amines; Analgesics; Analgesics - therapeutic use; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - therapeutic use; Antineoplastic Agents - therapeutic use; Biological and medical sciences; Breast Neoplasms - surgery; Breast Neoplasms - therapy; Chronic Disease; Combined Modality Therapy; Cyclohexanecarboxylic Acids; Double-Blind Method; Female; Gabapentin; gamma-Aminobutyric Acid; Humans; Mastectomy, Radical; Medical sciences; Mexiletine - therapeutic use; Middle Aged; Neuropharmacology; Pain Measurement - drug effects; Pain, Postoperative - drug therapy; Pharmacology. Drug treatments; Surveys and Questionnaires; Time Factors; Human; Postoperative; Gabapentin; Acute; Malignant tumor; Mexiletine; Mammary gland diseases; Analgesia; Chemotherapy; Chronic; Analgesic; Pain; Treatment; Surgery; Female; Mammary gland; Comparative study
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1097/00000539-200210000-00036

We investigated the analgesic efficacy of mexiletine and gabapentin on acute and chronic pain associated with cancer breast surgery in 75 patients. They were randomized to receive, in a double-blinded manner, mexiletine 600 mg/d, gabapentin 1200 mg/d, or placebo for 10 days. Anesthesia was standardized, and all patients had access to routine postoperative analgesics on demand. The visual analog scale score assessed pain at rest and after movement. Three months later, all patients were interviewed to identify intensity of chronic pain and analgesic requirements. Mexiletine and gabapentin reduced codeine consumed from the second to tenth day by 50% (P = 0.029; P = 0.018 and P = 0.035 for mexiletine versus control and gabapentin versus control comparisons, respectively). Total paracetamol consumption was also reduced during the same time (P = 0.0085; P = 0.007 and P = 0.011 for the mexiletine and gabapentin groups when compared with the control, respectively). Pain at rest and after movement was reduced by both drugs on the third postoperative day. Pain after movement also was reduced by gabapentin between the second and fifth postoperative day. Three months later, the incidence of chronic pain, its intensity, and need for analgesics were not affected by either treatment. However, burning pain was more frequent in the control group (P = 0.033). Patients undergoing breast surgery for cancer may develop chronic pain. We evaluated the effect of mexiletine and gabapentin on the acute and chronic pain after breast surgery for cancer. Both drugs reduced the postoperative analgesic requirements, and particularly, gabapentin reduced pain after movement. The overall incidence of chronic pain was unaffected except for burning pain.