Impact of Preoperative Aripiprazole on Postoperative Analgesia in Laparoscopic Hysterectomy: A Randomized Double-Blind Placebo-Controlled Trial.

OBJECTIVES: Aripiprazole is a second-generation atypical antipsychotic with worldwide clinical approval. Nevertheless, its perioperative antinociceptive application has not been studied. As a result, the purpose of this study was to investigate the analgesic effects of perioperative aripiprazole on reducing postoperative pain, as well as the possible adverse effects.

METHODS: This randomized controlled study enrolled eighty female patients scheduled for laparoscopic hysterectomy who were assigned randomly into two equal groups in 1:1; Aripiprazole group (n=40): patients received an aripiprazole 30 mg tablet orally three hours before surgery, and Placebo group (n=40): patients received a placebo tablet three hours before surgery. The 24-hour morphine consumption postoperatively was the primary outcome, and the time to the first analgesic request, sedation scores, and the incidence of perioperative adverse events were the secondary outcomes.

RESULTS: The mean 24-hour morphine consumption was significantly lower with aripiprazole (2.5±0.5 mg) than with placebo (23.7±1.6 mg) (Mean±SE -21.2±0.3, 95% CI: -21.7 to -20.6, P<0.001). In addition, mean time to the first analgesic request was significantly longer with aripiprazole (212.2±14.7 min) than with placebo (27.0±2.0 min) (Mean±SE 185.2±2.3, 95% CI: 180.5 to 189.8, P<0.001). Furthermore, aripiprazole group reported higher sedation scores (P<0.001). Bradycardia and hypotension were reported more frequently among patients in the aripiprazole group (P<0.05).

DISCUSSION: Aripiprazole was effective in reducing pain following laparoscopic hysterectomy. Although self-limited, side effects should be taken into consideration when using the medication perioperatively.