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Review article: The role of anticonvulsant drugs in postoperative pain management: a bench-to-bedside perspective

[Le rôle des anticonvulsivants dans le traitement de la douleur postopératoire : perspective d’une application]

From the Departments of Anesthesiology and Pharmacology & Toxicology, Kingston General Hospital, Queen’s University, Kingston, Ontario, Canada.

Address correspondence to: Dr. Ian Gilron, Director, Clinical Pain Research, Department of Anesthesiology, Queen’s University, Victory 2 Pavilion, 76 Stuart St, Kingston, Ontario K7L 2V7, Canada. Fax: 613-548-1375; E-mail: gilroni{at}post.queensu.ca

Purpose: Anticonvulsant drugs are effective in the treatment of chronic neuropathic pain but were not, until recently, thought to be useful in more acute conditions such as postoperative pain. However, similar to nerve injury, surgical tissue injury is known to produce neuroplastic changes leading to spinal sensitization and the expression of stimulus-evoked hyperalgesia and allodynia. Pharmacological effects of anticonvulsant drugs which may be important in the modulation of these postoperative neural changes include suppression of sodium channel, calcium channel and glutamate receptor activity at peripheral, spinal and supraspinal sites. The purpose of this article is to review preclinical evidence and clinical trial data describing the efficacy and safety of anticonvulsant drugs in the setting of postoperative pain management.

Source: A Medline search was performed to retrieve available literature on the basic and clinical pharmacology of anticonvulsant drugs as they pertain to postoperative pain management.

Principal findings: Numerous laboratory studies have described analgesic effects of different anticonvulsant drugs in experimental pain models. Furthermore, several recent clinical trials have shown that anticonvulsants may reduce spontaneous and movement-evoked pain, as well as decrease opioid requirements postoperatively. Some early findings suggest further that anticonvulsant drugs may alleviate postoperative anxiety, accelerate postoperative functional recovery and reduce chronic postsurgical pain.

Conclusion: Given the incomplete efficacy of currently available non-opioid analgesics, and the identified benefits of opioid sparing, anticonvulsant medications may be useful adjuncts for postoperative analgesia. Further research in this field is warranted.

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