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

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