Perioperative gabapentin’s effect on postoperative opioid use
Background: Previous studies have shown that perioperative gabapentin has no effect on remote pain cessation but have not linked it with effects on remote opioid cessation. Also, most trials were limited to immediate postoperative use during hospital admission; limited data were available with extensive postoperative longitudinal follow-up.
Dr. Anthi Katsouli
Study design: Randomized, double-blind, placebo-controlled study.
Setting: Tertiary referral teaching hospital.
Synopsis: A randomized, double-blind trial including a total of 1,805 patients aged 18-75 years who were scheduled for eligible surgery was conducted at a single-center, tertiary referral teaching hospital. The treatment group received 1,200 mg of gabapentin preoperatively followed by 600 mg 3 times a day postoperatively. Meanwhile, the placebo group received lorazepam 0.5 mg preoperatively followed by inactive placebo postoperatively for 72 hours. With use of intention to treat analysis, this study showed that perioperative gabapentin did not affect time to postoperative pain resolution. However, a modest increase in the rate of opioid cessation was uncovered. Specifically, there was a 24% increase in the rate (hazard ratio, 1.24; 95% confidence interval, 1.00-1.54; P = .05) of opioid cessation after hospital discharge, with a median time of 25 days in the gabapentin group versus 32 days in the placebo group.
One caveat to the outcomes is that use of a gabapentin regimen may have increased after discharge date, which could have biased the outcome.
Bottom line: Perioperative gabapentin may promote opioid cessation and prevent the development of chronic opioid use after surgery.
Citation: Hah J et al. Effect of perioperative gabapentin on postoperative pain resolution and opioid cessation in a mixed surgical cohort. JAMA Surg. 2018;153(4):303-11.
Dr. Katsouli is a hospitalist in the division of hospital medicine in the department of medicine at Loyola University Chicago, Maywood, Ill.
