A Comparative Analysis of the Effects of Oral Gabapentin and Intravenous Dexamethasone on Postoperative Pain Following Hysterectomy: A Randomized Clinical Trial

Background: Optimizing post-operative pain management is paramount for patient recovery and satisfaction. Non-opioid analgesic agents, such as gabapentin and dexamethasone, are frequently utilized as adjunctive therapies to attenuate opioid consumption and mitigate associated adverse effects. This study sought to compare the analgesic efficacy of oral gabapentin versus intravenous dexamethasone administered pre-operatively in women undergoing elective abdominal hysterectomy. Methods: In this randomized, single-blind clinical trial, 93 women scheduled for elective abdominal hysterectomy were randomly assigned to three cohorts (n = 31 each): oral gabapentin 600 mg, intravenous dexamethasone 8 mg, or a control group. Pain intensity was assessed using the Visual Analog Scale (VAS) at recovery and at 1, 6, 12, and 24 hours postoperatively. The requirement for supplemental analgesic (pethidine) intervention and postoperative complications were recorded. Data were analyzed using repeated measures ANOVA and Chi-square tests, with statistical significance defined as p < 0.05. Results: Both the gabapentin and dexamethasone groups demonstrated significantly lower pain scores compared to the control group at all time points (p < 0.001). No significant difference was observed between gabapentin and dexamethasone up to 12 hours postoperatively ; however, at 24 hours, gabapentin provided lower pain scores (nominal p = 0.029; this difference did not persist after Bonferroni correction). The need for rescue analgesics and the incidence of nausea/vomiting were significantly lower in the intervention groups compared to the control group (p = 0.013 and p = 0.005, respectively). No serious adverse events were noted. Conclusion: Pre-operative administration of oral gabapentin or intravenous dexamethasone effectively reduces post-operative pain and opioid requirements following hysterectomy. Although the difference at 24 hours did not meet the corrected threshold for statistical significance, gabapentin exhibited a trend toward more sustained analgesia, which may be attributable to its extended half-life. Both agents also mitigate postoperative nausea and vomiting, thereby enhancing patient comfort.