Efficacy of perioperative low dose oral gabapentin with melatonin on postoperative delirium and cognition status of the patients undergoing non cardiac surgery

Introduction: Various pharmacological and non-pharmacological strategies are advocated, without definitive results, to ameliorate stress induced post-operative cognitive disorder (POCD).Objective: To target the disturbed sleep component of patients perioperatively with melatonin and gabapentin combination.Methods: This prospective, double blind, randomized study was done on 130 patients of >50 years age, of either sex undergoing routine surgery under entropy guided general anesthesia. Melatonin 3mg and gabapentin 300mg orally was used in the perioperative periodin group 1 and placebo drugs in group 2 patients. Confusion assessment method (CAM score), mini mental state examination (MMSE) and Stanford sleepiness scale was used to assess the POCD of patients.Results: Incidence of delirium was 0% in group 1 and 27.69% in group 2 (p<0.0001). Low baseline cognition status represented by <25 MMSE score was seen in [89.23% (58 patients) of group, 92.3% (60 patients) of group 2] and was 96% (63 patients) in both the groups at time of discharge. The cognition decline (moderate and severe) was significantly higher in group 2 at all times (p≤0.003). The subjective sleep quality of group 1 patients was significantly better over control group (p<0.0001). Educational status, serum electrolytes, perioperative hemoglobin and serum sugar were not factors for its occurrence (p>0.05).Conclusion: Low dose melatonin with gabapentin significantly decreased the incidence of delirium, the severity of ognition status decline and improved the sleep quality of patients in the perioperative period.