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In response to the opioid crisis, surgeons nationwide have sought to decrease opioid use by adopting opioid-sparing multimodal medication regimens to treat perioperative pain. 1 For example, gabapentinoids (gabapentin and pregabalin) are now commonly administered during the perioperative period as part of “enhanced recovery after surgery Certain medicines can cause problems (complications) with your surgery unless you stop taking them before surgery. Talk with your health care provider about all of the medicines you take (including prescription medicines such as diabetes medicines, over-the-counter medicines, herbals, vitamins or other supplements) at least 10 days before surgery. The findings contradict guidelines published by the American Pain Society (APS) in 2016, which advocate “around the clock” use of gabapentin, pregabalin and other nonopioid drugs both before and after surgery. “The panel recommends use of gabapentin or pregabalin as part of a multimodal regimen in patients who undergo surgery. Orthopedic Surgery - how much more does a shoulder replacement weigh than a regular shoulder? Updated 26 Feb 2018 3 answers Why has my surgeon told me to stop taking gabapentin prior to my back surgery? In general, we ask patients not to take some common medications and supplements for 1-2 weeks before surgery. Those include: Anticoagulants , more commonly known as blood thinners, reduce the body’s ability to clot and increase the risk of serious bleeding. Compared with people who are less active prior to surgery, people who are more active prior to surgery do better after surgery. Just like you would train for a marathon or sporting event, you should prepare for surgery and anesthesia. We call this pre-habilitation, since it’s before surgery — rather than rehabilitation, which happens afterward. I've been told to stop taking my 600mg gabapentin 3 days prior to my back surgery. Plus stop taking my .5mg xanex and 15mg mirtazapine 2 days prior to surgery. I'm curious as to why? Blood Thinners: Heparin –stop 8 hours before surgery.Lovenox –stop 12 hours before surgery. Muscle relaxers, sleep aids, relaxants – stop the night before surgery. MIRALAX AND DULCOLAX BOWEL PREP INSTRUCTIONS Postoperative opioid consumption was reduced when using gabapentin within the initial 24 hours following surgery (standard mean difference −1.35, 95% confidence interval [CI]: −1.96 to −0.73; P <0.001). There was a significant reduction in morphine, fentanyl, and tramadol consumption (P <0.05). St. John’s Wort, Vitamin E, and Multivitamins containing Vitamin E should be stopped at least 14 days before surgery. Dietary Supplements: Any form of dietary supplements should be stopped no later than 7 days before surgery. The following is a list of common (but not all) medications you need to stop taking 5 days before surgery (unless otherwise noted). DO NOT stop taking any medication before you talk to your doctor! Please let your doctor or nurse practice manager (NPM) know if you have ANY questions about taking medications before your surgery! Discontinue for 6 days pre-surgery Phentermine / Topiramate (Qsymia®) -2 Inhibitors Discontinue according to time listed below: Jardiance (empafliflozin) 3 days before Surgery Invokana (canagliflozin) 3 days before Surgery renzavvy ( exagliflozin) 3 days before surgery Zynquista (Sotagliflozin) 3 days before surgery 2) If patient is taking gabapentin, do not order pregabalin. Inform patient to take gabapentin dose on DOS. 3) If patient is extremely frail or you have concerns about multiple drug interactions causing over sedation, it is OK if you don’t order the medication. The anesthesia team should look at these orders the day prior to surgery. 4) Vitamin E, vitamin C, vitamin K, B vitamins, fish oils, and all herbal supplements should all be STOPPED 1 week pre-surgery (including your multivitamin). If you’re planning to have surgery, you may need to take a break from some supplements and medications that can interfere with anesthesia. Tapering or slowly reducing your dose is recommended to stop taking gabapentin. Tapering off will help you avoid side effects. The timeline to reduce gabapentin depends on the individual You will need to temporarily stop taking the following medications before your surgery. These medications can thin your blood, change its clotting, and slow the healing process after surgery. If the choice is made to discontinue, consider discontinuing 4 to 6 weeks prior to surgery. EXCEPTION: Patients going for Stage 1 DBS should DISCONTINUE these medications on day of surgery. Obtain baseline ECG if none available within the last 3 months. Use caution if these agents are combined with other QT. prolonging medications. In most cases gabapentin does not need to be stopped before surgery, but as this is a very important medication for a number of conditions, it would be best to ask your doctor, as he is more familiar with your complete medical history. All oral contraceptives and hormones replacement therapy. You will need to consult your physician regarding plans for stopping these medications. Aggrenox, Coumadin, Ecotrin, Fragmin, Halfprin, Heparin, Lovenox, Orgaran, Persantine, Plavix, and Ticlid. Nardil (Phenelzine), Parnate (Tranylcypromine) Clopidogrel and ticagrelor - stop at least 5 days before surgery Prasugrel - stop 7 days before surgery Ticlopidine - stop 10 days before surgery Vitamin K Antagonists Discontinue 5 days before elective surgery and resume 12-24 hours after surgery Examples: ***When possible, check PT/INR on the day before Warfarin (Coumadin, Jantoven) surgery***
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