Perioperative Use of Gabapentinoids: Reply

Verret, Michael; Zarychanski, Ryan; Lauzier, François; Turgeon, Alexis F.

doi:10.1097/aln.0000000000003667

Cited by 5 publications

(13 citation statements)

References 6 publications

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“…The trials varied in terms of sample size (20-697 patients), 31,32 gabapentin regimen (single dose vs continued treatment with daily dose ranging from 300 mg to 1200 mg), surgery type (orthopedic, abdominal, and vascular), and study quality (low to high risk of bias). Several meta-analyses [3][4][5]12,13,33,34 concluded that reductions in pain intensity 24 hours after surgery and opioid-related adverse events associated with gabapentin and placebo were inconsistent and not clinically meaningful. An RCT by Hah et al 35 showed that perioperative gabapentin use had no effect on time to cessation of perioperative pain but reduced the median time to opioid cessation after surgery (25 days vs 32 days) compared with lorazepam.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, perioperative gabapentin use was associated with dizziness and visual disturbances. 13 Although there were no statistically significant differences in perioperative delirium, respiratory failure, ataxia, or falls, 13 the studies did not exclude the possibility of clinically meaningful adverse events owing to small sample sizes, underrepresentation of older patients, and heterogenous surgical procedures. The American Geriatrics Society Beers Criteria 15 lists gabapentin as a potentially inappropriate medication owing to its risk of sedation and respiratory depression, especially when used with opioids.…”

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confidence: 98%

“…9,10 Despite the widespread use of gabapentin, recent studies raised concerns about the marginal benefit and immediate harms of gabapentin use for perioperative pain management. 11 Studies, [12][13][14] including meta-analyses of RCTs, concluded that the evidence on gabapentin's effectiveness is low quality owing to inconsistent and imprecise results and that its analgesic and opioid-sparing effects may be clinically insignificant. Moreover, perioperative gabapentin use was associated with dizziness and visual disturbances.…”

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Perioperative Gabapentin Use and In-Hospital Adverse Clinical Events Among Older Adults After Major Surgery

et al. 2022

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ImportanceGabapentin has been increasingly used as part of a multimodal analgesia regimen to reduce opioid use in perioperative pain management. However, the safety of perioperative gabapentin use among older patients remains uncertain.ObjectiveTo examine in-hospital adverse clinical events associated with perioperative gabapentin use among older patients undergoing major surgery.Design, Setting, and ParticipantsThis retrospective cohort study using data from the Premier Healthcare Database included patients aged 65 years or older who underwent major surgery at US hospitals within 7 days of hospital admission from January 1, 2009, to March 31, 2018, and did not use gabapentin before surgery. Data were analyzed from June 14, 2021, to May 23, 2022.ExposuresGabapentin use within 2 days after surgery.Main Outcomes and MeasuresThe primary outcome was delirium, identified using diagnosis codes, and secondary outcomes were new antipsychotic use, pneumonia, and in-hospital death between postoperative day 3 and hospital discharge. To reduce confounding, 1:1 propensity score matching was performed. Risk ratios (RRs) and risk differences (RDs) with 95% CIs were estimated.ResultsAmong 967 547 patients before propensity score matching (mean [SD] age, 76.2 [7.4] years; 59.6% female), the rate of perioperative gabapentin use was 12.3% (119 087 patients). After propensity score matching, 237 872 (118 936 pairs) gabapentin users and nonusers (mean [SD] age, 74.5 [6.7] years; 62.7% female) were identified. Compared with nonusers, gabapentin users had increased risk of delirium (4040 [3.4%] vs 3148 [2.6%]; RR, 1.28 [95% CI, 1.23-1.34]; RD, 0.75 [95% CI, 0.75 [0.61-0.89] per 100 persons), new antipsychotic use (944 [0.8%] vs 805 [0.7%]; RR, 1.17 [95% CI, 1.07-1.29]; RD, 0.12 [95% CI, 0.05-0.19] per 100 persons), and pneumonia (1521 [1.3%] vs 1368 [1.2%]; RR, 1.11 [95% CI, 1.03-1.20]; RD, 0.13 [95% CI, 0.04-0.22] per 100 persons), but there was no difference in in-hospital death (362 [0.3%] vs 354 [0.2%]; RR, 1.02 [95% CI, 0.88-1.18]; RD, 0.00 [95% CI, –0.04 to 0.05] per 100 persons). Risk of delirium among gabapentin users was greater in subgroups with high comorbidity burden than in those with low comorbidity burden (combined comorbidity index <4 vs ≥4: RR, 1.20 [95% CI, 1.13-1.27] vs 1.40 [95% CI, 1.30-1.51]; RD, 0.41 [95% CI, 0.28-0.53] vs 2.66 [95% CI, 2.08-3.24] per 100 persons) and chronic kidney disease (absence vs presence: RR, 1.26 [95% CI, 1.19-1.33] vs 1.38 [95% CI, 1.27-1.49]; RD, 0.56 [95% CI, 0.42-0.69] vs 1.97 [95% CI, 1.49-2.46] per 100 persons).Conclusion and RelevanceIn this cohort study, perioperative gabapentin use was associated with increased risk of delirium, new antipsychotic use, and pneumonia among older patients after major surgery. These results suggest careful risk-benefit assessment before prescribing gabapentin for perioperative pain management.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 98%

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confidence: 99%

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Perioperative Gabapentin Use and In-Hospital Adverse Clinical Events Among Older Adults After Major Surgery

et al. 2022

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“…1 9 10 11 However, others have concluded that results have been heterogeneous depending on the type and severity of pain, and that the absolute effects observed may have been overestimated by publication bias in favour of the analgesic effect of gabapentin. 12 In a recent systematic review and meta-analysis of the perioperative use of gabapentinoids for management of postoperative pain in humans, 24 the authors found that there were no clinically significant differences in postoperative acute, subacute and chronic pain with the use of gabapentinoids; they also found that their use was associated with a higher incidence of adverse events (dizziness and visual disturbance). The authors conclusively stated that the routine use of gabapentinoids for managing acute postoperative pain in adults is not recommended.…”

Section: Discussionmentioning

confidence: 99%

“…The authors conclusively stated that the routine use of gabapentinoids for managing acute postoperative pain in adults is not recommended. 24 Translation of these findings to veterinary patients is challenging because of potential differences in drug pharmacokinetics and pharmacodynamics.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Gabapentin in the Treatment of Postoperative Pain after a Tibial Plateau Levelling Osteotomy in Dogs

2023

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Objective Pain management is an essential component of perioperative patient care. Multimodal pain management strategies have the potential to provide more effective analgesia than a single drug. The objective of this study was to evaluate the use of gabapentin as an adjuvant to carprofen for the management of postoperative pain following tibial plateau levelling osteotomy surgery. Materials and Methods The study included 20 adult dogs with unilateral cranial cruciate ligament disease, assigned to one of two postoperative treatment groups, receiving either carprofen (4.4 mg/kg orally every 24 hours) or carprofen plus gabapentin 20 mg/kg, orally, every 8 hours beginning the night prior to surgery and continuing for 14 days postoperatively. The patients were blindly assessed postoperatively using the Short Form of the Glasgow Composite Measure Pain Scale (GCMPS-SF) and limb function measured by pressure platform gait analysis. There was no difference in body weight, age, affected hindlimb or sex between groups. Result No differences were found in (GCMPS-SF) pain assessments; after surgery, a (GCMPS-SF) more than or equal to 6 was documented in four dogs (two dogs in each group) and no dog required rescue analgesia more than once. Conclusion In this population of dogs, the addition of oral gabapentin at the dose and frequency studied did not improve subjective or objective outcome measures for perioperative pain control following tibial plateau levelling osteotomy surgery.

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Trends in the Use of Gabapentinoids and Opioids in the Postoperative Period Among Older Adults

et al. 2023

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ImportanceIn response to the opioid epidemic, recommendations from some pain societies have encouraged surgeons to embrace multimodal pain regimens with the intent of reducing opioid use in the postoperative period, including by prescribing gabapentinoids.ObjectiveTo describe trends in postoperative prescribing of both gabapentinoids and opioids after a variety of surgical procedures by examining nationally representative Medicare data and further understand variation by procedure.Design, Setting, and ParticipantsThis serial cross-sectional study of gabapentinoid prescribing from January 1, 2013, through December 31, 2018, used a 20% US Medicare sample. Gabapentinoid-naive patients 66 years or older undergoing 1 of 14 common noncataract surgical procedures performed in older adults were included. Data were analyzed from April 2022 to April 2023.ExposureOne of 14 common surgical procedures in older adults.Main Outcomes and MeasuresRate of postoperative prescribing of gabapentinoids and opioids, defined as a prescription filled between 7 days before the procedure and 7 days after discharge from surgery. Additionally, concomitant prescribing of gabapentinoids and opioids in the postoperative period was assessed.ResultsThe total study cohort included 494 922 patients with a mean (SD) age of 73.7 (5.9) years, 53.9% of whom were women and 86.0% of whom were White. A total of 18 095 patients (3.7%) received a new gabapentinoid prescription in the postoperative period. Of those receiving a new gabapentinoid prescription, 10 956 (60.5%) were women and 15 529 (85.8%) were White. After adjusting for age, sex, race and ethnicity, and procedure type in each year, the rate of new postoperative gabapentinoid prescribing increased from 2.3% (95% CI, 2.2%-2.4%) in 2014 to 5.2% (95% CI, 5.0%-5.4%) in 2018 (P &lt; .001). While there was variation between procedure types, almost all procedures saw an increase in both gabapentinoid and opioid prescribing. In this same period, opioid prescribing increased from 56% (95% CI, 55%-56%) to 59% (95% CI, 58%-60%) (P &lt; .001). Concomitant prescribing also increased from 1.6% (95% CI, 1.5%-1.7%) in 2014 to 4.1% (95% CI, 4.0%-4.3%) in 2018 (P &lt; .001).Conclusions and RelevanceThe findings of this cross-sectional study of Medicare beneficiaries suggest that new postoperative gabapentinoid prescribing increased without a subsequent downward trend in the proportion of patients receiving postoperative opioids and a near tripling of concurrent prescribing. Closer attention needs to be paid to postoperative prescribing for older adults, especially when using multiple types of medications, which can have adverse drug events.

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Perioperative Use of Gabapentinoids: Reply

Cited by 5 publications

References 6 publications

Perioperative Gabapentin Use and In-Hospital Adverse Clinical Events Among Older Adults After Major Surgery

Perioperative Gabapentin Use and In-Hospital Adverse Clinical Events Among Older Adults After Major Surgery

Evaluation of Gabapentin in the Treatment of Postoperative Pain after a Tibial Plateau Levelling Osteotomy in Dogs

Trends in the Use of Gabapentinoids and Opioids in the Postoperative Period Among Older Adults

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