A comparison of analgesic efficacy between oral pregabalin, gabapentin, and melatonin as non-opioid anaesthesia for robotic-assisted laparoscopic surgeries: A prospective randomized double-blinded clinical study

Opioid-sparing anesthesia is increasingly used in surgery, though effectiveness varies. Given the anxiety-pain correlation, anxiolytics like gabapentinoids and melatonin may offer benefits. This study compares the preemptive use of pregabalin, gabapentin, and melatonin for postoperative analgesia in robotic-assisted laparoscopic surgeries (RALS). The aim of this study is to investigate postoperative analgesia in patients undergoing robotic-assisted laparoscopic surgeries under non-opioid anesthesia. The objectives are to evaluate perioperative hemodynamics, assess the perioperative sedation score during the surgical procedures, determine the requirement for rescue analgesia in the postoperative period, and measure the perioperative anxiety score in patients undergoing these surgeries. Sixty patients, aged 18-60 with ASA PS grade 1 & 2 and BMI < 35 kg/m², undergoing elective robotic-assisted laparoscopic surgeries (RALS) were randomly assigned to receive pregabalin (Group P), gabapentin (Group G), or melatonin (Group M). After standard pre-anesthetic assessments and premedication, patients received pregabalin 150 mg, gabapentin 900 mg, or melatonin 6 mg one hour before surgery. Hemodynamics and anxiety, VAS, and sedation scores were monitored postoperatively at 1, 2, 6, and 12 hours. Primary outcome was postoperative analgesia assessed by VAS, with rescue analgesia administered for VAS > 4. Baseline characteristics were balanced among groups. Gabapentin significantly reduced VAS scores (1.25 ± 0.44) and extended time to rescue analgesia (9.48 ± 0.69 hours). Anxiety scores and Ramsay sedation scores (1.45 ± 0.51) were comparable, but Group G showed lower sedation. Hemodynamics remained stable. Gabapentin improved postoperative pain outcomes in RALS, supporting its use for individualized pain management in these surgeries. Differences in pain intensity, time to rescue analgesia, and sedation levels highlight the need for personalized approaches. Further research in various surgical contexts is recommended to optimize perioperative care.