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Gabapentinoids have been shown to both decrease postoperative pain and, secondarily, decrease opiate dependence. This is a growing field in medical research, although it is relatively lacking in the specialty of lower extremity orthopedic surgery. Twelve studies identified show that gabapentin treatment resulted in decreased pain and/or opioid consumption following orthopedic surgery. 20,29,30 Thus, as reported in our results, the administration of gabapentin, even with one 300 mg pre-operative dose, may effectively aid physicians in decreasing patients’ post-operative pain and opioid NMDA antagonists: Ketamine as part of a multi-modal pain management plan. Ketamine can be used as part of multi-modal pain management. Intravenous (IV) ketamine infusions and boluses have been successfully used in a multi-modal approach to manage pain for orthopedic surgery throughout the perioperative period (Chin & Lewis, 2018; Kadic, Haren, Wilder-Smith, Bruhn, Driessen, de Waal Malefijt As gabapentin has been commonly used off-label for pain management in orthopedics, a retrospective analysis was conducted to investigate trends in orthopedic prescriptions of gabapentin considering novel state regulations. Gabapentin as a third-generation antiepileptic drug that selectively affects the nociceptive process has been used for pain relief after THA. This meta-analysis was conducted to examine the efficacy of gabapentin in THA. We reviewed 8 articles (609 patients) addressing the effect of gabapentin perioperatively (Table) in regard to lower extremity orthopedic surgery. Ten other reports were reviewed for the general use of perioperative gabapentin outside of orthopedics, its pharmacology, and the rationale behind its use as an adjunct perioperative pain medication. A free text search of “gabapentin orthopedic surgery,” “gabapentinoid orthopedic surgery,” “gabapentin pharmacology,” and “gabapentin surgery” were performed, and 8 articles specific to lower extremity orthopedic procedures and including 609 patients were analyzed. Our last electronic PubMed search was performed in December 2017. Pain management is a critical aspect of orthopedic care, with opioids having long been a mainstay in treatment. 1 However, as the opioid epidemic in the United States garnered national attention, the healthcare system experienced pronounced shifts in guidelines and prescribers judiciously sought alternatives 1, 2, 3 such as gabapentin, an anticonvulsive drug originally approved by the FDA in Gabapentin, pregabalin, and duloxetine have potential to further decrease post-operative pain and lower opioid dependency. This review creates an opening for further research in hand surgery to assess an updated protocol for pain management to reduce opioid dependency. As gabapentin has been commonly used off-label for pain management in orthopedics, a retrospective analysis was conducted to investigate trends in orthopedic pre-scriptions of gabapentin considering novel state regulations. Gabapentin is routinely used in preoperative multimodal anesthesia to reduce pain following total joint arthroplasty (TJA) surgery. Evolving evidence has shown it is ineffective in reducing postoperative pain and should be used cautiously in this patient population due to its adverse effects. The include a tiered decision tree that prioritizes the use of the most efficacious therapeutic modalities for the treatment of acute and chronic pain. (J Am Anim Hosp Assoc 2022; 58:55–76. DOI 10.5326/JAAHA-MS-7292) JAAHA.ORG 55 VETERINARY PRACTICE GUIDELINES *These guidelines areNorth supported by generous educational grants 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. purpose of this work was to implement an evidence-based practice (EBP) change in a small preadmission testing center. Utilizing the Melnyk EBP model, implementation occurred over 30 days. Pharmacy reports were used to determine the number of doses of gabapentin 300 mg dispensed from the ASU Phase II Omnicell 30 days before implementation and 30 days following implementation. During Prior opioid use is perhaps the most significant risk of increased opioid use after orthopedic trauma injuries. 29, 36 Evidenced alternative strategies to limit opioid use and control pain include scheduled acetaminophen, NSAIDs in the immediate postoperative period, and perioperative nerve blockade. 10 , 14 , 15 , 20 , 21 , 23 , 37 Gabapentin is routinely used in preoperative multimodal anesthesia to reduce pain following total joint arthroplasty (TJA) surgery. Evolving evidence has shown it is ineffective in reducing postoperative pain and should be used cautiously in this patient population due to its adverse effects. A review on the use of gabapentin in neuropathic and post-operative pain in pediatrics has demonstrated different doses when used as an adjuvant in the treatment of pain, with doses between 15 and 50 mg/kg/day, compared to the doses for seizure treatment being between 20 and 100 mg/kg/day. A strategy used by some surgeons is to use gabapentin preoperatively at bedtime a couple of days before surgery. It can be increased to 2 or 3 times daily post-operatively if needed. If patients are unable to use gabapentin, then pregabalin can be substituted. Gabapentin is contraindicated in patients with myasthenia gravis and myoclonus disorders. Academy of Orthopaedic Surgeons (AAOS), The Hip Society, The Knee Society and The American Society of Regional Anesthesia and Pain Medicine (ASRA) have worked together to develop evidence-based guidelines on the use of gabapentinoids in primary total joint arthroplasty (TJA). the use of gabapentin (OR 1.47; p <0.001) (10). In 2020, the Canadian Perioperative Anesthesia Clinical Trials Group performed a meta-analysis of randomized controlled trials to determine the efficacy and risks of perioperative use of gabapentinoids including gabapentin and pregabalin.
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