Gabapentin Improves Postoperative Opioid Cessation, But Not Pain Resolution

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In a per protocol analysis, perioperative gabapentin promoted earlier opioid cessation.
In a per protocol analysis, perioperative gabapentin promoted earlier opioid cessation.

According to the results of a recent study published in JAMA Surgery, compared with placebo, gabapentin administered pre- and postoperatively may reduce the time to postoperative opioid cessation, but was not shown to improve postoperative pain resolution.

In this randomized controlled trial, adults (mean age, 56.7±11.7 years; 62.4% women) scheduled for surgery (including thoracotomy, total hip or knee replacement, and mastectomy) were randomly assigned either to receive gabapentin 1200 mg preoperatively and gabapentin 600 mg postoperatively 3 times a day (n=208) or to receive lorazepam 0.5 mg preoperatively and placebo postoperatively (n=202). Researchers evaluated the time to pain resolution (5 consecutive reports of 0 out of 10 for pain at surgical site on the numeric rating scale), the time to opioid cessation (5 consecutive reports of no opioid use), and the proportion of patients with pain or opioid use at 6 months and 1 year postsurgery.

The median time to pain resolution was greater in the gabapentin group compared with the placebo group (84 vs 73 days). In multivariable analysis, perioperative gabapentin had no effect on time to pain resolution, resulting in early study termination after a preplanned interim analysis. The gabapentin group had a shorter median time to opioid cessation compared with the placebo group (25 vs 32 days; hazard ratio, 1.24; P =.05). In a per protocol analysis, perioperative gabapentin still promoted earlier opioid cessation (HR, 1.37; P =.02).

The rates of adverse events were not significantly different between groups (P =.70). Participants in the gabapentin vs placebo group reported a lower rate of constipation (61.5% vs 72.8%; P =.02), a higher rate of impaired coordination (42.3% vs 32.7%; P =.03), and a higher rate of rash (13.0% vs 32.7%; P =.04).

The study authors concluded that "Identifying gabapentin as an important adjuvant to promote definitive opioid cessation rather than merely reducing immediate postoperative opioid requirements has important and timely clinical implications in the context of the national epidemic of opioid overdose deaths and addiction."

Reference

Hah J, Mackey SC, Schmidt P, et al. Effect of perioperative gabapentin on postoperative pain resolution and opioid cessation in a mixed surgical cohort: A randomized clinical trial [published online December 13, 2017]. JAMA Surg. doi: 10.1001/jamasurg.2017.4915

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