OBJECTIVE:We hypothesize that gabapentin (GBP) may be a safe and tolerable option to reduce narcotics and other pain medications after Aneurysmal subarachnoid hemorrhage (aSAH).BACKGROUND:aSAH is characterized by sudden severe headache which can persist for weeks after initial bleeding. Use of opioid in this group of patients is not desired.DESIGN/METHODS:We retrospectively reviewed a consecutive series of aSAH patients from January to June 2013. Opioid, NSAID corticosteroid and visual analogue scale (VAS) were tabulated. Total opioid and steroid use per day was tabulated using IV morphine equivalents and steroid scale from Micromedex 2.0.RESULTS:We identified 45 SAH patients, out of which 12 patients were selected. 9 (75%) patients were females. Mean age was 54 years old (range, 33- 75, SD 12.8 years). Modified Fisher scale was 4 in 6 patients, 3 in 4 patients and 2 in the remaining patient. GBP was started on hospital day (HD) # 1 in 9 patients typically with a dose of 100- 200mg TID. Most of patients achieved a maintenance dose of GBP 300mg, 600mg or 900mg tid by HD # 4 . There was no tolerability, or adverse drug or safety events noted with GBP dose escalation. Opioid and NSAID usage showed two peaks, one being early from HD# 4 to 6 and later around HD# day13. Total VAS score showed three peaks in headache intensity, the first occurring within the first 3 days, the second by HD# 9-11, and third by HD# 16. Interestingly the VAS score rise on day 9 correlated with a rise in CSF WBC/RBC ratio and subsequent corticosteroid use .CONCLUSIONS:Gabapentin appears relatively safe and tolerable in aSAH patients, and may reduce total narcotic and NSAID use over the first two weeks, even with rapid dose titration. We observed two distinct peaks in opioid use, the second possibly due to SAH-related aseptic meningitis which may be steroid-responsive.Study Supported by: None
Disclosure: Dr. Dhakal has nothing to disclose. Dr. Mayes has nothing to disclose. Dr. Richie has nothing to disclose.
Original Article: http://www.neurology.org/cgi/content/short/82/10_Supplement/P2.122?rss=1
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