Gabapentin for acute and chronic post-surgical pain
1Lecturer, Department of Anaesthesiology, Aretaieio Hospital, School of Medicine, National and Capodistrian University of Athens
2Professor and Chairperson, Department of Anaesthesiology, Aretaieio Hospital, School of Medicine, National and Capodistrian University of Athens
DOI: 10.22514/SV21.052007.5 Vol.2,Issue S1,May 2007 pp.42-51
Published: 01 May 2007
Pain after surgery remains a significant clinical problem as it impairs recovery adversely and may lead to the transition to chronic pain. Opioid medications are far from ideal agents in suppressing postoperative pain. Gabapentin –an anticonvul-sant with antihyperalgesic properties- originally efficacious against neuropathic pain seems to be very promising for the management of pain after surgery as well. Gabapentin, by decreasing noxious stimulus-induced excitatory neurotransmitter release at the spinal cord, may attenuate central sensitization, and eventually decrease postoperative late pain. Furthermore, different sites of action may be pertinent to a synergistic effect with opioids. Both actions (antihyperalgesic effect and syn-ergy with opioid analgesia) may manifest as analgesia and/or opioid-sparing effect after surgery. This has been confirmed by a variety of clinical studies, in a variety of settings. Most of these studies have shown that either single preoperative or repeated doses of gabapentin, continued for up to a few days after surgery, decrease acute postoperative pain and/or need for postoperative opioids. This has been shown for procedures such as abdominal and vaginal hysterectomy, breast surgery for cancer (mastectomy or lumpectomy), lumbar discectomy and spinal fusion, laparoscopic cholecystectomy and other, such as ENT surgery. Finally, a few studies indicate that perioperative gabapentin may as well decrease chronic pain several weeks after surgery.
pain postoperative, pain chronic, post-mastectomy pain, anti-convulsants, gabapentin
AIKATERINI MELEMENI,CHRYSSOULA STAIKOU,ARGYRO FASSOULAKI. Gabapentin for acute and chronic post-surgical pain. Signa Vitae. 2007. 2(S1);42-51.
1. Chung F, Ritchie E, Su J. Postoperative pain in ambulatory surgery. Anesth Analg 1997;85:808-16.
2. Chung F, Un V, Su J. Postoperative symptoms 24 hours after ambulatory anaesthesia. Can J Anaesth 1996;43:1121-27.
3. Gold BS, Kitz DS, Lecky JH, Neuhaus JM. Unanticipated admission to the hospital following ambulatory surgery. JAMA 1989;262:3008-10.
4. Pavlin DJ, Rapp SE, Polissar NL, Malmgren JA, Koerschgen M, Keyes H. Factors affecting discharge time in adult outpatients. Anesth Analg 1998;87:816-26.
5. Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet 2006;367:1618-25.
6. Perkins FM, Kehlet H. Chronic pain as an outcome of surgery. A review of predictive factors. Anesthesiology 2000;93:1123-33.
7. Fassoulaki A, Sarantopoulos C, Melemeni A, Hogan Q. EMLA reduces acute and chronic pain after breast surgery for cancer. Reg Anesth Pain Med 2000;25:350-55.
8. Fassoulaki A, Sarantopoulos C, Melemeni A, Hogan Q. Regional block and mexiletine: the effect on pain after cancer breast surgery. Reg Anesth Pain Med 2001;26:223-28.
9. Fassoulaki A, Triga A, Melemeni A, Sarantopoulos C. Multimodal analgesia with gabapentin and local anesthetics prevents acute and chronic pain after breast surgery for cancer. Anesth Analg 2005;101:1427-32.
10. Poleshuck EL, Katz J, Andrus CH, Hogan LA, Jung BF, Kulick DI, Dworkin RH. Risk factors for chronic pain following breast cancer surgery: a prospective study. J Pain 2006;7:626-34.
11. Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg 2003;97:534-40.
12. Chia YY, Liu K, Wang JJ, Kuo MC, Ho ST. Intraoperative high dose fentanyl induces postoperative fentanyl tolerance. Can J Anaesth 1999;46:872-77.
13. Guignard B, Bossard AE, Coste C, Sessler DI, Lebrault C, Alfonsi P, Fletcher D, Chauvin M. Acute opioid tolerance: intraoperative remifentanil increases postoperative pain and morphine requirement. Anesthesiology 2000;93:409-17.
14. Li X, Angst MS, Clark JD. Opioid-induced hyperalgesia and incisional pain. Anesth Analg 2001;93:204-09.
15. Vinik HR, Kissin I. Rapid development of tolerance to analgesia during remifentanil infusion in humans. Anesth Analg 1998;86:1307-11.
16. Law PY, Wong YH, Loh HH. Molecular mechanisms and regulation of opioid receptor signalling. Annu Rev Pharmacol Toxicol 2000;40:389-430.
17. Ueda H, Inoue M, Matsumoto T. Protein kinase C-mediated inhibition of mu-opioid receptor internalization and its involvement in the development of acute tolerance to peripheral mu-agonist analgesia. J Neurosci 2001;21:2967-73.
18. Ueda H, Inoue M, Mizuno K. New approaches to study the development of morphine tolerance and dependence. Life Sci 2003;74:313-20.
19. Chung F, Mezei G. Factors contributing to a prolonged stay after ambulatory surgery. Anesth Analg 1999;89:1352-59.
20. White PF. The role of non-opioid analgesic techniques in the management of pain after ambulatory surgery. Anesth Analg 2002;94:577-85.
21. Rose MA, Kam PC. Gabapentin: pharmacology and its use in pain management. Anaesthesia 2002;57:451-62.
22. Backonja M, Beydoun A, Edwards KR, Schwartz SL, Fonseca V, Hes M, LaMoreaux L, Garofalo E. Gabapentin for the symptomatic treatment of painful neuropathy in patients with diabetes mellitus: a randomized controlled trial. JAMA 1998;280:1831-36.
23. Backonja MM. Gabapentin monotherapy for the symptomatic treatment of painful neuropathy: a multicenter, double-blind, placebo-controlled trial in patients with diabetes mellitus. Epilepsia 1999;40 Suppl 6:S57-59.
24. Rowbotham M, Harden N, Stacey B, Bernstein P, Magnus-Miller L. Gabapentin for the treatment of postherpetic neuralgia: a randomized controlled trial. JAMA 1998; 280:1837-42.
25. Khan OA. Gabapentin relieves trigeminal neuralgia in multiple sclerosis patients. Neurology 1998;51:611-14.
26. Newshan G. HIV neuropathy treated with gabapentin. AIDS 1998;12:219-21.
27. Caraceni A, Zecca E, Bonezzi C, Arcuri E, Yaya Tur R, Maltoni M, et al. Gabapentin for neuropathic cancer pain: a randomized controlled trial from the Gabapentin Cancer Pain Study Group. J Clin Oncol 2004;22:2909-17.
28. Caraceni A, Zecca E, Martini C, De Conno F. Gabapentin as an adjuvant to opioid analgesia for neuropathic cancer pain. J Pain Symptom Manage 1999;17:441-45.
29. Caraceni A, Zecca E, Martini C, De Conno F. Differences in gabapentin efficacy for cancer pain more apparent than real? J Pain Symptom Manage 2001;21:93-94.
30. Mellick GA, Mellick LB. Reflex sympathetic dystrophy treated with gabapentin. Arch Phys Med Rehabil 1997;78:98-105.
31. Mellick GA, Mellicy LB, Mellick LB. Gabapentin in the management of reflex sympathetic dystrophy. J Pain Symptom Manage 1995;10:265-66.
32. Thurlow RJ, Brown JP, Gee NS, Hill DR, Woodruff GN. [3H] gabapentin may label a system-L-like neutral amino acid carrier in brain. Eur J Pharmacol 1993;247:341-45.
33. Thurlow RJ, Hill DR, Woodruff GN. Comparison of the autoradiographic binding distribution of (3H)-gabapentin with excitatory amino acid receptor and amino acid uptake site distributions in rat brain. Br J Pharmacol 1996;118: 457-65.
34. Thurlow RJ, Hill DR, Woodruff GN. Comparison of the uptake of [3H]-gabapentin with the uptake of L-[3H]-leucine into rat brain synaptosomes. Br J Pharmacol 1996;118:449-56.
35. Taylor CP, Gee NS, Su TZ, Kocsis JD, Welty DF, Brown JP, Dooley DJ, Boden P, Singh L. A summary of mechanistic hypotheses of gabapentin pharmacology. Epilepsy Res 1998;29:233-49.
36. Taylor CP, Vartanian MG, Yuen PW, Bigge C, Suman-Chauhan N, Hill DR. Potent and stereospecific anticonvulsant activity of 3-isobutyl GABA relates to in vitro binding at a novel site labeled by tritiated gabapentin. Epilepsy Res 1993;14:11-15.
37. Reimann W. Inhibition by GABA, baclofen and gabapentin of dopamine release from rabbit caudate nucleus: are there common or different sites of action? Eur J Pharmacol 1983;94: 341-44.
38. Schlicker E, Reimann W, Gothert M. Gabapentin decreases monoamine release without affecting acetylcholine release in the brain. Arzneimittelforschung 1985;35:1347-49.
39. Wamil AW, McLean MJ. Limitation by gabapentin of high frequency action potential firing by mouse central neurons in cell culture. Epilepsy Res 1994;17:1-11
40. Abdi S, Lee DH, Chung JM. The anti-allodynic effects of amitriptyline, gabapentin, and lidocaine in a rat model of neuropathic pain. Anesth Analg 1998;87:1360-66.
41. Pan HL, Eisenach JC, Chen SR. Gabapentin suppresses ectopic nerve discharges and reverses allodynia in neuropathic rats. J Pharmacol Exp Ther 1999;288:1026-30.
42. Patel MK, Gonzalez MI, Bramwell S, Pinnock RD, Lee K. Gabapentin inhibits excitatory synaptic transmission in the hyperalgesic spinal cord. Br J Pharmacol 2000;130:1731-34.
43. Field MJ, Oles RJ, Lewis AS, McCleary S, Hughes J, Singh L. Gabapentin (neurontin) and S-(+)-3-isobutylgaba represent a novel class of selective antihyperalgesic agents. Br J Pharmacol 1997;121:1513-22.
44. Rock DM, Kelly KM, Macdonald RL. Gabapentin actions on ligand- and voltage-gated responses in cultured rodent neurons. Epilepsy Res 1993;16:89-98.
45. Gee NS, Brown JP, Dissanayake VU, Offord J, Thurlow R, Woodruff GN. The novel anticonvulsant drug, gabapentin (Neurontin), binds to the alpha2delta subunit of a calcium channel. J Biol Chem 1996;271:5768-76.
46. Carlton SM, Zhou S. Attenuation of formalin-induced nociceptive behaviors following local peripheral injection of gabapentin. Pain 1998;76:201-07.
47. Shistik E, Ivanina T, Puri T, Hosey M, Dascal N. Ca2+ current enhancement by alpha 2/delta and beta subunits in Xenopus oocytes: contribution of changes in channel gating and alpha 1 protein level. J Physiol 1995;489( Pt 1):55-62.
48. Dooley DJ, Donovan CM, Meder WP, Whetzel SZ. Preferential action of gabapentin and pregabalin at P/Q-type voltage-sensitive calcium channels: inhibition of K+-evoked (3H)-norepinephrine release from rat neocortical slices. Synapse 2002;45:171-90.
49. Dooley DJ, Mieske CA, Borosky SA. Inhibition of K (+)-evoked glutamate release from rat neocortical and hippocampal slices by gabapentin. Neurosci Lett 2000;280:107-10.
50. Fink K, Meder W, Dooley DJ, Gothert M. Inhibition of neuronal Ca(2+) influx by gabapentin and subsequent reduction of neurotransmitter release from rat neocortical slices. Br J Pharmacol 2000;130:900-06.
51. Shimoyama M, Shimoyama N, Hori Y. Gabapentin affects glutamatergic excitatory neurotransmission in the rat dorsal horn. Pain 2000;85:405-14.
52. Sarantopoulos CD, McCallum JB, Rigaud M, Fuchs A, Kwok WM, Hogan QH. Opposing effects of spinal nerve ligation on calcium-activated potassium currents in axotomized and adjacent mammalian primary afferent neurons. Brain Res 2006 (In
Press) Available from URL: http://dx.doi.org/10.1016/j.brainres.2006.11.055
53. Stefani A, Spadoni F, Bernardi G. Gabapentin inhibits calcium currents in isolated rat brain neurons. Neuropharmacology 1998;37:83-91.
54. Stefani A, Spadoni F, Giacomini P, Lavaroni F, Bernardi G. The effects of gabapentin on different ligand- and voltage-gated currents in isolated cortical neurons. Epilepsy Res 2001;43:239-48.
55. Sarantopoulos C, McCallum JB, Kwok WM, Hogan Q. Beta-escin diminishes voltage-gated calcium current rundown in perforated patch-clamp recordings from rat primary afferent neurons. J Neurosci Methods 2004;139:61-68.
56. Sarantopoulos C, McCallum B, Kwok WM, Hogan Q. Gabapentin decreases membrane calcium currents in injured as well as in control mammalian primary afferent neurons. Reg Anesth Pain Med 2002;27:47-57.
57. Sarantopoulos C, McCallum B, Sapunar D, Kwok WM, Hogan Q. ATP-sensitive potassium channels in rat primary afferent neurons: the effect of neuropathic injury and gabapentin. Neurosci Lett 2003;343:185-89.
58. Freiman TM, Kukolja J, Heinemeyer J, Eckhardt K, Aranda H, Rominger A. Modulation of K+-evoked (3H)-noradrenalin release from rat and human brain slices by gabapentin: involvement of KATP channels. Naunyn Schmiedebergs Arch Pharmacol 2001;363:537-42.
59. Freiman TM, Surges R, Kukolja J, Heinemeyer J, Klar M, van Velthoven V, Zentner J. K(+)-evoked ((3)H)-norepinephrine release in human brain slices from epileptic and non-epileptic patients is differentially modulated by gabapentin and pinacidil.
Neurosci Res 2006;55:204-10.
60. Jehle T, Lagreze WA, Blauth E, Knorle R, Schnierle P, Lucking CH. Gabapentin-lactam (8-aza-spiro [5,4] decan-9-on; GBP-L) inhibits oxygen glucose deprivation-induced (3H)-glutamate release and is a neuroprotective agent in a model of acute retinal ischemia. Naunyn Schmiedebergs Arch Pharmacol 2000;362:74-81.
61. Jiang C, Haddad GG. Modulation of K+ channels by intracellular ATP in human neocortical neurons. J Neurophysiol 1997;77:93-102.
62. Politi DM, Rogawski MA. Glyburide-sensitive K+ channels in cultured rat hippocampal neurons: activation by cromakalim and energy-depleting conditions. Mol Pharmacol 1991;40:308-15.
63. Stefani MR, Nicholson GM, Gold PE. ATP-sensitive potassium channel blockade enhances spontaneous alternation performance in the rat: a potential mechanism for glucose-mediated memory enhancement. Neuroscience 1999;93:557-63.
64. Ghosh A, Ginty DD, Bading H, Greenberg ME. Calcium regulation of gene expression in neuronal cells. J Neurobiol 1994;25:294-303.
65. Ghosh A, Greenberg ME. Calcium signaling in neurons: molecular mechanisms and cellular consequences. Science 1995;268:239-47.
66. Meir A, Ginsburg S, Butkevich A, Kachalsky SG, Kaiserman I, Ahdut R, et al. Ion channels in presynaptic nerve terminals and control of transmitter release. Physiol Rev 1999;79:1019-88.
67. Takahashi T, Momiyama A. Different types of calcium channels mediate central synaptic transmission. Nature 1993;366:156-58.
68. Chaplan SR, Pogrel JW, Yaksh TL. Role of voltage-dependent calcium channel subtypes in experimental tactile allodynia. J Pharmacol Exp Ther 1994;269:1117-23.
69. Hogan QH, McCallum JB, Sarantopoulos C, Aason M, Mynlieff M, Kwok WM, Bosnjak ZJ. Painful neuropathy decreases membrane calcium current in mammalian primary afferent neurons. Pain 2000;86:43-53.
70. Attal N, Brasseur L, Parker F, Chauvin M, Bouhassira D. Effects of gabapentin on the different components of peripheral and central neuropathic pain syndromes: a pilot study. Eur Neurol 1998;40:191-200.
71. Stanfa LC, Singh L, Williams RG, Dickenson AH. Gabapentin, ineffective in normal rats, markedly reduces C-fibre evoked responses after inflammation. Neuroreport 1997;8:587-90.
72. Kanai A, Sarantopoulos C, McCallum JB, Hogan Q. Painful neuropathy alters the effect of gabapentin on sensory neuron excitability in rats. Acta Anaesthesiol Scand 2004;48:507-12.
73. Field MJ, Holloman EF, McCleary S, Hughes J, Singh L. Evaluation of gabapentin and S-(+)-3-isobutylgaba in a rat model of postoperative pain. J Pharmacol Exp Ther 1997;282:1242-46.
74. Whiteside GT, Harrison J, Boulet J, Mark L, Pearson M, Gottshall S, Walker K. Pharmacological characterisation of a rat model of incisional pain. Br J Pharmacol 2004;141:85-91.
75. Dirks J, Petersen KL, Rowbotham MC, Dahl JB. Gabapentin suppresses cutaneous hyperalgesia following heat-capsaicin sensitization. Anesthesiology 2002; 97:102-07.
76. Gilron I. Is gabapentin a „Broad-spectrum“ analgesic? Anesthesiology 2002;97:537- 39.
77. Rowbotham DJ. Gabapentin: a new drug for postoperative pain? Br J Anaesth 2006;96:152-55.
78. Ho KY, Gan TJ, Habib AS. Gabapentin and postoperative pain-a systematic review of randomized controlled trials. Pain 2006;126:91-101.
79. Fassoulaki A, Patris K, Sarantopoulos C, Hogan Q. The analgesic effect of gabapentin and mexiletine after breast surgery for cancer. Anesth Analg 2002;95:985-91.
80. Macdonald L, Bruce J, Scott NW, Smith WC, Chambers WA. Long-term follow-up of breast cancer survivors with post-mastectomy pain syndrome. Br J Cancer 2005;92: 225-30.
81. Tasmuth T, von Smitten K, Hietanen P, Kataja M, Kalso E. Pain and other symptoms after different treatment modalities of breast cancer. Ann Oncol 1995;6:453-59.
82. Akechi T, Okuyama T, Imoto S, Yamawaki S, Uchitomi Y. Biomedical and psychosocial determinants of psychiatric morbidity among postoperative ambulatory breast cancer patients. Breast Cancer Res Treat 2001;65:195-202.
83. Miaskowski C, Dibble SL. The problem of pain in outpatients with breast cancer. Oncol Nurs Forum 1995;22:791-97.
84. Stevens PE, Dibble SL, Miaskowski C. Prevalence, characteristics, and impact of postmastectomy pain syndrome: an investigation of women‘s experiences. Pain 1995;61:61-68.
85. Dirks J, Fredensborg BB, Christensen D, Fomsgaard JS, Flyger H, Dahl JB. A randomized study of the effects of single-dose gabapentin versus placebo on postoperative pain and morphine consumption after mastectomy. Anesthesiology 2002;97:560-64.
86. Dierking G, Duedahl TH, Rasmussen ML, Fomsgaard JS, Moiniche S, Romsing J. Effects of gabapentin on postoperative morphine consumption and pain after abdominal hysterectomy: a randomized, double-blind trial. Acta Anaesthesiol Scand 2004;48:322-27.
87. Turan A, Karamanlioglu B, Memis D, Usar P, Pamukcu Z, Ture M. The analgesic effects of gabapentin after total abdominal hysterectomy. Anesth Analg 2004;98:1370-73.
88. Rorarius MG, Mennander S, Suominen P, Rintala S, Puura A, Pirhonen R, Salmelin R, Haanpaa M, Kujansuu E, Yli-Hankala A. Gabapentin for the prevention of postoperative pain after vaginal hysterectomy. Pain 2004;110:175-81.
89. Gilron I, Orr E, Tu D, O’Neill JP, Zamora JE, Bell AC. A placebo-controlled randomized clinical trial of perioperative administration of gabapentin, rofecoxib and their combination for spontaneous and movement-evoked pain after abdominal hysterectomy. Pain 2005;113:191-200.
90. Turan A, White PF, Karamanlioglu B, Memis D, Tasdogan M, Pamukcu Z, Yavuz E. Gabapentin: an alternative to the cyclooxygenase-2 inhibitors for perioperative pain management. Anesth Analg 2006;102:175-81.
91. Fassoulaki A, Stamatakis E, Petropoulos G, Siafaka I, Hassiakos D, Sarantopoulos C. Gabapentin attenuates late but not acute pain after abdominal hysterectomy. Eur J Anaesthesiol 2006;23:136-41.
92. Fassoulaki A., Melemeni A., Stamatakis E., Petropoulos G., Sarantopoulos C. A combination of gabapentil and local anaesthetics attenuates acute and late pain after abdominal hysterectomy. Eur J Anaesthesiol 2007 (In press).
93. Turan A, Karamanlioglu B, Memis D, Hamamcioglu MK, Tukenmez B, Pamukcu Z. Analgesic effects of gabapentin after spinal surgery. Anesthesiology 2004;100:935-38.
94. Pandey CK, Sahay S, Gupta D, Ambesh SP, Singh RB, Raza M, Singh U, Singh PK. Preemptive gabapentin decreases postoperative pain after lumbar discoidectomy. Can J Anaesth 2004;51:986-89.
95. Radhakrishnan M, Bithal PK, Chaturvedi A. Effect of preemptive gabapentin on postoperative pain relief and morphine consumption following lumbar laminectomy and discectomy: a randomized, double-blinded, placebo-controlled study. J Neurosurg Anesthesiol 2005;17:125-28.
96. Pandey CK, Navkar DV, Giri PJ, Raza M, Behari S, Singh RB, Singh U, Singh PK. Evaluation of the optimal preemptive dose of gabapentin for postoperative pain relief after lumbar diskectomy: a randomized, double-blind, placebo-controlled study. J Neurosurg Anesthesiol 2005;17: 65-68.
97. Jensen TS, Krebs B, Nielsen J, Rasmussen P. Phantom limb, phantom pain and stump pain in amputees during the first 6 months following limb amputation. Pain 1983;17:243-56.
98. Jensen TS, Krebs B, Nielsen J, Rasmussen P. Non-painful phantom limb phenomena in amputees: incidence, clinical characteristics and temporal course. Acta Neurol Scand 1984;70:407-14.
99. Jensen TS, Krebs B, Nielsen J, Rasmussen P. Immediate and long-term phantom limb pain in amputees: incidence, clinical characteristics and relationship to preamputation limb pain. Pain 1985;21:267-78.
100. Nikolajsen L, Ilkjaer S, Kroner K, Christensen JH, Jensen TS. The influence of preamputation pain on postamputation stump and phantom pain. Pain 1997;72:393- 405.
101. Bone M, Critchley P, Buggy DJ. Gabapentin in postamputation phantom limb pain: a randomized, double-blind, placebo-controlled, cross-over study. Reg Anesth Pain Med 2002;27:481-86.
102. Nikolajsen L, Finnerup NB, Kramp S, Vimtrup AS, Keller J, Jensen TS. A randomized study of the effects of gabapentin on postamputation pain. Anesthesiology 2006;105:1008-15.
103. Menigaux C, Adam F, Guignard B, Sessler DI, Chauvin M. Preoperative gabapentin decreases anxiety and improves early functional recovery from knee surgery. Anesth Analg 2005;100:1394-99.
104. Adam F, Menigaux C, Sessler DI, Chauvin M. A single preoperative dose of gabapentin (800 milligrams) does not augment postoperative analgesia in patients given interscalene brachial plexus blocks for arthroscopic shoulder surgery. Anesth Analg 2006;103:1278-82.
105. Mikkelsen S, Hilsted KL, Andersen PJ, Hjortso NC, Enggaard TP, Jorgensen DG, Hansen M, Henriksen J, Dahl JB. The effect of gabapentin on post-operative pain following tonsillectomy in adults.Acta Anaesthesiol Scand 2006;50:809-15.
106. Turan A, Memis D, Karamanlioglu B, Yagiz R, Pamukcu Z, Yavuz E. The analgesic effects of gabapentin in monitored anesthesia care for ear-nose-throat surgery. Anesth Analg 2004;99:375-78.
107. Pandey CK, Priye S, Singh S, Singh U, Singh RB, Singh PK. Preemptive use of gabapentin significantly decreases postoperative pain and rescue analgesic requirements in laparoscopic cholecystectomy. Can J Anaesth 2004;51:358-63.
108. Sihoe AD, Lee TW, Wan IY, Thung KH, Yim AP. The use of gabapentin for postoperative and post-traumatic pain in thoracic surgery patients. Eur J Cardiothorac Surg 2006;29:795-99.
109. Turan A, Kaya G, Karamanlioglu B, Pamukcu Z, Apfel CC. Effect of oral gabapentin on postoperative epidural analgesia. Br J Anaesth 2006;96:242-46.
Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.
Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.
Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.
IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.
Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.
Scopus: CiteScore 0.5(2019) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.
Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.