The use of probiotic/synbiotic supplementation is associated with a significant reduction in the risk of developing postoperative sepsis in patients undergoing elective GI surgery. Probiotic/synbiotic supplementation is a valuable adjunct in the care of patients undergoing GI surgery. Additional studies are required to determine the optimal dose and strain of probiotic/synbiotic.

ObjectivesEffective postoperative pain management is crucial in the care of surgical patients. Opioids, which are commonly used in managing postoperative pain, have a potential for tolerance and addiction, along with sedating side effects. Gabapentin’s use as a multimodal analgesic regimen to treat neuropathic pain has been documented as having favorable side effects. This meta-analysis examined the use of preoperative gabapentin and its impact on postoperative opioid consumption.Materials and methodsA comprehensive literature search was conducted to identify randomized control trials that evaluated preoperative gabapentin on postoperative opioid consumption. The outcomes of interest were cumulative opioid consumption following the surgery and the incidence of vomiting, somnolence, and nausea.ResultsA total of 1,793 patients involved in 17 randomized control trials formed the final analysis for this study. Postoperative opioid consumption was reduced when using gabapentin within the initial 24 hours following surgery (standard mean difference −1.35, 95% confidence interval [CI]: −1.96 to −0.73; P<0.001). There was a significant reduction in morphine, fentanyl, and tramadol consumption (P<0.05). While a significant increase in postoperative somnolence incidence was observed (relative risk 1.30, 95% CI: 1.10–1.54, P<0.05), there were no significant effects on postoperative vomiting and nausea.ConclusionThe administration of preoperative gabapentin reduced the consumption of opioids during the initial 24 hours following surgery. The reduction in postoperative opioids with preoperative gabapentin increased postoperative somnolence, but no significant differences were observed in nausea and vomiting incidences. The results from this study demonstrate that gabapentin is more beneficial in mastectomy and spinal, abdominal, and thyroid surgeries. Gabapentin is an effective analgesic adjunct, and clinicians should consider its use in multimodal treatment plans among patients undergoing elective surgery.

S. Arumugam et al. 298CI 0.38 to 1.04; p = 0.07). Conclusion: Perioperative IV Mg administration reduces opioid use in the first 24 hours postoperatively without any serious adverse events. The decreased need for postoperative opioids in the Mg group was not associated with a decrease in opioid-related side effects such as nausea and vomiting. Mg is an efficacious adjunct for postoperative analgesia and should be considered in multimodal analgesic treatment plans. Additional studies are required to optimize the Mg dose and timing, and to address whether specific opioids display unique benefit or resistance to adjunct Mg therapy.

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Sepsis is a potentially fatal condition, accounting for over 1 million hospitalizations annually in the United States, with mortality rates as high as 40%. Patients undergoing gastrointestinal (GI) surgery are especially susceptible to sepsis, due to bacterial translocation secondary to surgical trauma and the use of antibiotics. Probiotics and synbiotics, which have been hypothesized to counteract disturbances in the intestinal flora and reduce pathogenic bacterial colonization, have been proposed for the prevention and treatment of a variety of GI conditions, including sepsis. Recent randomized control trials and meta-analyses evaluating the use of probiotic/symbiotic supplementation in elective surgical patients have demonstrated a significant reduction in the risk of developing postoperative sepsis in patients with the use of probiotic/synbiotics. Coupled with the prevention of numerous other GI symptoms, such as diarrhea, probiotics should be considered in all elective surgical GI patients.