Gabapentin can decrease acute pain and morphine consumption in spinal surgery patients

Peng, Chuangang; Li, Chen; Qu, Jing; Wu, D

doi:10.1097/md.0000000000006463

Cited by 39 publications

(21 citation statements)

References 25 publications

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“…The literature is heterogeneous on whether preoperative gabapentin has sedating or antiemetic effects [6,8,16,24]. However, in this study patients had a similar requirement for rescue antiemetics in the first 24 hours and there were no statistically significant differences in the PACU Aldrete scores between the study groups to suggest increased sedation.…”

Section: Discussioncontrasting

confidence: 43%

Effect of preoperative gabapentin and acetaminophen on opioid consumption in video-assisted thoracoscopic surgery: a retrospective study

Qiu

Perrino

Zurich

et al. 2018

Rom J Anaesth Int Care

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Background: Patients undergoing video-assisted thoracoscopic surgery (VATS) are particularly vulnerable to opioid-induced sedation and hypoventilation. Accordingly, reducing opioid consumption in these patients is a primary goal of multimodal analgesic regimens. Although administration of preoperative gabapentin and acetaminophen has been shown to decrease postoperative opioid consumption in other surgeries, this approach has not been studied in VATS lobectomy. Our objective was to examine the impact of the addition of preoperative gabapentin and acetaminophen to a VATS lobectomy multimodal analgesic plan on postoperative opioid consumption, nausea/vomiting, and sedation.Methods: With IRB approval, we performed a retrospective chart review of patients who underwent VATS lobectomy at a single center between 2015 and 2016 to identify those that received preoperative gabapentin and acetaminophen and those that received neither. Opioid consumption in the first 24 hours postoperatively was converted to oral morphine equivalents (OMEQs). Postoperative sedation was evaluated using Aldrete scores and the percentage of patients requiring antiemetics in the first 24 hours was also examined.Results: There were 133 patients who were opioid naive: 31 received preoperative gabapentin and acetaminophen and 102 received neither. Median 24 hour postoperative opioid consumption was lower but not statistically significant in the gabapentin and acetaminophen group vs. neither (36 mg vs. 45 mg, p = 0.08). Notably, there was a change in the distribution of opioid consumption, with no patients in the gabapentin and acetaminophen group requiring more than 200 mg OMEQ in the first 24 hours postoperatively. No significant difference in postoperative nausea/vomiting or sedation was observed.Conclusions: The addition of preoperative gabapentin and acetaminophen to a VATS lobectomy multimodal analgesic regimen reduces the incidence of high dose postoperative opioid consumption without observed negative side effects.

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Section: Discussioncontrasting

confidence: 43%

Effect of preoperative gabapentin and acetaminophen on opioid consumption in video-assisted thoracoscopic surgery: a retrospective study

Qiu

Perrino

Zurich

et al. 2018

Rom J Anaesth Int Care

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“…22,23 Previous systematic reviews have weaknesses. First, most were designed to look at specific surgical populations [24][25][26][27][28][29][30][31][32][33] with often a limited sampling frame or a specific type of drugs [34][35][36][37][38][39][40] when pregabalin and gabapentin share the same mechanism of action and comparable pharmacologic properties. 41,42 Second, the concept of minimally important difference 43 for pain intensity was never considered in previous work, neither was the statistical reliability of the findings quantified.…”

Section: Perioperative Medicinementioning

confidence: 99%

Perioperative Use of Gabapentinoids for the Management of Postoperative Acute Pain

Verret¹,

Lauzier²,

Zarychanski³

et al. 2020

Anesthesiology

320

193

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Background Widely used for acute pain management, the clinical benefit from perioperative use of gabapentinoids is uncertain. The aim of this systematic review was to assess the analgesic effect and adverse events with the perioperative use of gabapentinoids in adult patients. Methods Randomized controlled trials studying the use of gabapentinoids in adult patients undergoing surgery were included. The primary outcome was the intensity of postoperative acute pain. Secondary outcomes included the intensity of postoperative subacute pain, incidence of postoperative chronic pain, cumulative opioid use, persistent opioid use, lengths of stay, and adverse events. The clinical significance of the summary estimates was assessed based on established thresholds for minimally important differences. Results In total, 281 trials (N = 24,682 participants) were included in this meta-analysis. Compared with controls, gabapentinoids were associated with a lower postoperative pain intensity (100-point scale) at 6 h (mean difference, −10; 95% CI, −12 to −9), 12 h (mean difference, −9; 95% CI, −10 to −7), 24 h (mean difference, −7; 95% CI, −8 to −6), and 48 h (mean difference, −3; 95% CI, −5 to −1). This effect was not clinically significant ranging below the minimally important difference (10 points out of 100) for each time point. These results were consistent regardless of the type of drug (gabapentin or pregabalin). No effect was observed on pain intensity at 72 h, subacute and chronic pain. The use of gabapentinoids was associated with a lower risk of postoperative nausea and vomiting but with more dizziness and visual disturbance. Conclusions No clinically significant analgesic effect for the perioperative use of gabapentinoids was observed. There was also no effect on the prevention of postoperative chronic pain and a greater risk of adverse events. These results do not support the routine use of pregabalin or gabapentin for the management of postoperative pain in adult patients. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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“…Gabapentinoids (gabapentin or pregabalin) has been used as an adjunct for PPM in orthopaedics and major gynaecological surgery frequently [ 36 , 37 , 38 ]. Peng et al [ 39 ] found a high dose (>900 mg) of gabapentin to be more effective in reducing PP after spine surgery. However, a meta-analysis [ 36 ] revealed no difference in pain scores after total knee arthroplasty between patients provided with the gabapentinoid class of drugs and a placebo.…”

Section: Multimodal Analgesiamentioning

confidence: 99%

Role of Multimodal Analgesia in the Evolving Enhanced Recovery after Surgery Pathways

et al. 2018

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Enhanced recovery after surgery (ERAS) are specially designed multimodal perioperative care pathways which are intended to attain and improve rapid recovery after surgical interventions by supporting preoperative organ function and attenuating the stress response caused by surgical trauma, allowing patients to get back to normal activities as soon as possible. Evidence-based protocols are prepared and published to implement the conception of ERAS. Although they vary amongst health care institutions, the main three elements (preoperative, perioperative, and postoperative components) remain the cornerstones. Postoperative pain influences the quality and length of the postoperative recovery period, and later, the quality of life. Therefore, the optimal postoperative pain management (PPM) applying multimodal analgesia (MA) is one of the most important components of ERAS. The main purpose of this article is to discuss the concept of MA in PPM, particularly reviewing the use of opioid-sparing measures such as paracetamol, nonsteroid anti-inflammatory drugs (NSAIDs), other adjuvants, and regional techniques.

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Gabapentin can decrease acute pain and morphine consumption in spinal surgery patients

Cited by 39 publications

References 25 publications

Effect of preoperative gabapentin and acetaminophen on opioid consumption in video-assisted thoracoscopic surgery: a retrospective study

Effect of preoperative gabapentin and acetaminophen on opioid consumption in video-assisted thoracoscopic surgery: a retrospective study

Perioperative Use of Gabapentinoids for the Management of Postoperative Acute Pain

Role of Multimodal Analgesia in the Evolving Enhanced Recovery after Surgery Pathways

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