Perioperative gabapentin linked with ‘modest’ impact on opioid cessation following surgery
Investigators found perioperative gabapentin compared with placebo did not impact the time to postoperative pain resolution. However, gabapentin did have a “modest” impact on opioid cessation in patients who underwent surgery.
"This is the first, randomized, double-blinded clinical trial demonstrating the effectiveness of perioperative oral gabapentin in accelerating the rate of opioid cessation following surgery at a 2-year follow-up,” John G. Costouros, MD, FACS, told Healio.com/Orthopedics. “This is especially relevant as we physicians continue to care for patients and prescribe medications during the current opioid epidemic and may warrant routine use of gabapentin to promote opioid cessation and prevent chronic opioid use"
In a double-blind, placebo-controlled trial, Costouros and colleagues randomized 202 patients who underwent surgery to preoperatively and postoperatively receive active placebo followed by inactive placebo and randomized 208 patients to receive gabapentin. Eligible surgeries included total hip replacement, total knee replacement, thoracotomy, video-assisted thoracscopic surgery, hand surgery, carpel tunnel surgery, knee arthroscopy, shoulder arthroplasty, shoulder arthroscopy, mastectomy and breast lumpectomy.
Patients were followed for 2 years postoperatively. Time to pain resolution was the primary outcome. Other outcomes included time to opioid cessation (defined as five consecutive reports of no opioid use) and the percentage of patents who had continued pain or used opioids at 6 months and 1 year.
Both groups had similar baseline characteristics. Investigators noted the time to pain cessation was not impacted by perioperative gabapentin in the intention-to-treat analysis. However, patients who received gabapentin had a 24% increase in the rate of opioid cessation following surgery. There was no difference between the treatment groups with regard to the number of adverse events. The rate of medication discontinuation due to sedation or dizziness was not significantly different among the groups. – by Monica Jaramillo
Disclosures: Hah reports she received grant K23DA035301. Please see the full study for a list of all other authors’ relevant financial disclosures.