Gabapentin and Post Tonsillectomy Pain-The Next Best Thing?

This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Tonsillectomy is the second most common childhood ambulatory surgical procedure, and in the United States alone it is performed in over half a million children a year (1). The two major indications for tonsillectomy are recurrent tonsillitis or tonsillar hypertrophy that causes airway obstruction and sleep-disordered breathing. Tonsillectomy is associated with multiple postop-erative complications, some of which are potentially life threatening. Bleeding is a common complication post-tonsillectomy and can lead to hospitalization in up to 4% of cases (2). Postoperative pain is also common, can be severe, and can lead to poor oral intake, dehydration and possibly weight loss if prolonged. Post-operative nausea and vomiting can occur in up to 70% of patients and may contribute to dehydration, or disruption of the surgical site if severe retching or vomiting occurs (1). The potential tonsillectomy complications make optimal postop-erative management of tonsillectomy difficult. Adequate pain control is required to ensure rapid return to oral intake, and hospital discharge, but the analgesics commonly utilized after tonsillectomy can actually increase the risk of postoperative complications. Non-steroidal anti-inflammatories increase the risk of postoperative bleeding (3). Opioid medications increase the risk of nausea and vomiting, and also the ominous risk of respiratory depression in the patients with sleep disordered breathing. Acetaminophen alone provides less pain relief than opioids, and requires more rescue analgesia (4). An effective analgesic that does not increase the risk of postoperative bleeding, nausea, vomiting, or respiratory depression would be extremely useful in the management of tonsillectomy patients. Gabapentin may be a medication that meets these requirements. An analogue of γ-aminobutyric acid, it was introduced in the early 1990's as an anti-epileptic medication. Although it never enjoyed much success in the prevention or treatment of seizures, gabapentin was soon found to have analgesic properties that made it an effective modality in the treatment of chronic neuropathic pain. Further investigation demonstrated its effectiveness in acute postoperative pain (5). Gabapentin has been shown to decrease the acute postoperative pain scores and opioid requirements in multiple surgical procedures, including hysterectomy (6), thyroidectomy (7), cholecystectomy (8), caesarean delivery (9), and various orthopaedic procedures (10, 11). Ga-bapentin may also have a role in preventing the development of chronic postoperative pain (12), and for reducing …