Effect of gabapentin pretreatment on myoclonus after etomidate: a randomized, double-blind, placebo-controlled study

Yılmaz Çakirgöz, Mensure; Demirel, İsmail; Duran, Esra; Özer, Ayşe Belin; Hancı, Volkan; Türkmen, Ülkü Aygen; Aydın, Ahmet; Ersoy, Ayşın; Büyükyıldırım, Aslıhan

doi:10.1016/j.bjane.2014.11.014

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Scientific Articles • Rev. Bras. Anestesiol. 66 (04) • Jul-Aug 2016 • https://doi.org/10.1016/j.bjane.2014.11.014 linkcopy

Effect of gabapentin pretreatment on myoclonus after etomidate: a randomized, double-blind, placebo-controlled study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Aim: To evaluate the effects of three different doses of gabapentin pretreatment on the incidence and severity of myoclonic movements linked to etomidate injection.

Method: One hundered patients, between 18 and 60 years of age and risk category American Society of Anesthesiologists I-II, with planned elective surgery under general anesthetic were included in the study. The patients were randomly divided into four groups and 2 h before the operation were given oral capsules of placebo (Group P, n = 25), 400 mg gabapentin (Group G400, n = 25), 800 mg gabapentin (Group G800, n = 25) or 1200 mg gabapentin (Group G1200, n = 25). Side effects before the operation were recorded. After preoxygenation for anesthesia induction 0.3 mg kg⁻¹ etomidate was administered for 10 s. A single anesthetist with no knowledge of the study medication evaluated sedation and myoclonic movements on a scale between 0 and 3. Two minutes after induction, 2 µg kg⁻¹ fentanyl and 0.8 mg kg⁻¹ rocuronium were administered for tracheal intubation.

Results: Demographic data were similar. Incidence and severity of myoclonus in Group G1200 and Group G800 were significantly lower than in Group P; sedation incidence and level were appreciably higher compared to Group P and Group G400. While there was no difference in the incidence of myoclonus between Group P and Group G400, the severity of myoclonus in Group G400 was lower than in the placebo group. In the two-hour period before induction other than sedation none of the side effects related to gabapentin were observed in any patient.

Conclusion: Pretreatment with 800 mg and 1200 mg gabapentin 2 h before the operation increased the level of sedation and reduced the incidence and severity of myoclonic movements due to etomidate.

KEYWORDS Etomidate; Injection pain; Myoclonus; Gabapentin

	Group P (n = 25)	Group G400 (n = 25)	Group G800 (n = 25)	Group G1200 (n = 25)
Age (years)	35.5 ± 12.4	34.9 ± 6.2	36.1 ± 9.4	35.8 ± 12.4
BMI (kg/m²)	24.0 ± 3.6	23.8 ± 3.0	23.9 ± 4.8	23.6 ± 3.3
Gender (male/female)	13/12	12/13	14/11	12/13
ASA physical status (I/II)	11/14	12/13	13/12	14/11

	Group P (n = 25)	GroupG400 (n = 25)	Group G800 (n = 25)	Group G1200 (n = 25)	p
Severity of myoclonus					0.006^a a Fisher exact test.
None (0)	6 (24)	11 (44)	18 (72)^f f p < 0.02 compared with group P. Comparisons for severity of myoclonus median.	17 (68)^f f p < 0.02 compared with group P. Comparisons for severity of myoclonus median.
Mild (1)	7 (28)	8(32)	2(8)^f f p < 0.02 compared with group P. Comparisons for severity of myoclonus median.	3 (12)^f f p < 0.02 compared with group P. Comparisons for severity of myoclonus median.
Moderate (2)	8 (32)	6 (24)	5 (20)	5 (20)
Severe (3)	4 (16)	0 (0)	0 (0)	0 (0)
Myoklonus (%)	19 (76)	14 (56)	7 (28)^d d p < 0.01 compared with group P. ,^e e p < 0.05 compared with group G400. Comparisons for severity levels of myoclonus.	8 (32)^d d p < 0.01 compared with group P.	0.002^b b Chi-square test.
Severity of myoclonus Median (min-max) (0-3)	1 (0-3)	1 (0-2)^g g p < 0.05 compared with group P.	0 (0-2)^g g p < 0.05 compared with group P.	0 (0-2)^g g p < 0.05 compared with group P.	0.002^c c Kruskal Wallis test. Comparisons for incidence of myoclonus.
Relative risk (95% CI)		1.36 (0.9-2.0)	2.7 (1.39-5.28)	2.38 (1.29-4.38)

	Group P (n = 25)	Group G400 (n = 25)	Group G800 (n = 25)	Group G1200 (n = 25)	p
Sedation n (%)	3 (12)	6 (24)	14 (56)^c c p < 0.002 compared with group P. ,^d d p < 0.05 compared with group 400.	16 (64)^c c p < 0.002 compared with group P. ,^d d p < 0.05 compared with group 400.	<0.001^a a Chi-square test p < 0.001. Intensities of sedation with four groups
Sedation score median (0-3)	0 (0-1)	0 (0-1)	1 (0-1)^c c p < 0.002 compared with group P. ,^d d p < 0.05 compared with group 400.	1 (0-1)^c c p < 0.002 compared with group P. ,^d d p < 0.05 compared with group 400.	<0.001^b b Fisher-exact test/Kruskal Wallis test p < 0.001.
Relative risk of sedation (95% CI) compared with Group P		0.5 (0.14-1.78)	0.21 (0.7-0.66)	0.19 (0.06-0.56)

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Sociedade Brasileira de Anestesiologia R. Professor Alfredo Gomes, 36, 22251-080 Botafogo RJ Brasil, Tel: +55 21 2537-8100, Fax: +55 21 2537-8188 - Campinas - SP - Brazil
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[TFN1] Data are given as number of patients or mean ± standard deviation. ASA - American Society of Anesthesiologists.