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A significant number of RCTs have demonstrated conflicting results in the use of preoperative gabapentin. 19 Bharti et al 20 studied gabapentin administration among patients (n=40) undergoing mastectomy (20 received gabapentin and 20 received placebo) and demonstrated a reduction in the amount of morphine required during the initial 24 hours Gabapentinoids were also ineffective in preventing chronic pain from developing after surgery, one of the primary justifications for using the drugs postoperatively. Become a member and receive career-enhancing benefits. Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. The purpose of this review is to critically appraise the evidence for the use of gabapentinoids for acute pain management and its impact on the development of chronic pain after surgery. Recent findings: Recent meta-analyses have revealed that prior data likely have overestimated the beneficial effects of gabapentinoids in acute perioperative Perioperative gabapentin, 1200 mg, administered preoperatively plus 600 mg every 8 hours continued for 72 hours after surgery did not affect time to pain cessation, the rate of pain resolution, or the proportion of patients with chronic pain at 6 months or 1 year following surgery. Perioperative gabapentin upped the risk of delirium, new antipsychotic use, and pneumonia in older adults after major surgery, a retrospective study showed. Gabapentin is an anticonvulsant medication but demonstrates benefits in neuropathic and chronic pain. 28 In patients undergoing ambulatory hand procedures, preoperative gabapentin was shown to reduce postoperative pain medication consumption significantly and prolong the time to the patient’s first postoperative pain medication request versus Purpose of review: This review summarizes the risks and benefits of gabapentinoids (gabapentin and pregabalin) for perioperative pain control and the controversies surrounding their use in a variety of settings. We review current literature with the goal of providing patient-centric and procedure-specific recommendations for the use of these More than one-fifth of older adults prescribed gabapentin postoperatively filled a prescription >90 days after discharge, especially among patients with more comorbidities and concurrent prolonged opioid use, increasing the risk of adverse drug events and polypharmacy. They found that gabapentin resulted in a 35% reduction in total analgesic consumption in the first 24 hours following surgery. Gabapentin also resulted in 27% to 39% reduction in visual analog scale (VAS) pain scores in the first 24 hours postoperatively. Similarly, aside from 24 h after surgery, gabapentin significantly reduced pain with movement (25–27,31,34,35,37,38) by 18% to 28% (VAS 8.2 mm to 10.2 mm) after surgery . The pooled effects on VAS pain scores displayed significant heterogeneity, which was not explained by subgroup analyses based on surgical procedure, gabapentin dose or study The Cleveland Clinic study had patients take a preemptive dose of three drugs: acetaminophen, the nerve pain medication gabapentin and the NSAID celecoxib (Celebrex). “Giving non-opioid pain medications before may help prevent the cascade of pain-causing chemicals that comes from your central nervous system after surgery,” explains Memtsoudis. Peri-operative gabapentin administration is effective in reducing pain scores, opioid requirements and opioid-related adverse effects in the first 24 hours after surgery. No serious side-effects were observed, though sedation was associated with gabapentin use. In summary, the administration of gabapentin was effective in decreasing postoperative narcotic consumption and the incidence of pruritus. There was a high risk of selection bias and a higher heterogeneity of knee flexion range in this analysis. Gabapentin for Postoperative Pain 1 Gabapentin for Postoperative Pain Management in Lumbar Fusion Surgery Eli A Perez BS1, Emanuel Ray BS1, Brian J Park MD1, Colin J Gold MD1, Ryan M Carnahan PharmD MS2, Matthew Banks PhD3, Robert D. Sanders MBBS 4,5, Catherine R Olinger MD6, Rashmi N Mueller MD1,7, Royce W Woodroffe MD1 The total fentanyl consumed after surgery in the first 24 h in the gabapentin group (233.5±141.9) was significantly less than in the placebo group (359.6±104.1; p<0.05). Turan et al., 2006 22 Turkey: Prospective: 40 patients Lower extremity surgery: Gabapentin (n= 20) 1.2 g 1 day before and for 2 days after surgery Gabapentin is a novel drug used for the treatment of postoperative pain with antihyperalgesic properties and a unique mechanism of action, which differentiates it from other commonly used drugs. Various studies have shown that perioperative use of gabapentin reduces postoperative pain. Among patients with new prescriptions, 23% (n=4,031) continued to receive gabapentin prescriptions at 90+ days after surgery. Those with prolonged use were more likely to be women (24% vs 21%), be non-white (24% vs 23%) and have undergone emergency surgery (38% vs 22%). Gabapentin appears safe and well tolerated when used for persistent post-operative and post-traumatic pain in thoracic surgery patients, although minor side effects do occur. Gabapentin may relieve refractory chest wall pain in some of these patients, particularly those with more severe pain.
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