SLR - March 2019 - Leslie H. Pyle
Reference: Hah J, Mackey S, Schmidt P, McCue R, Humphreys K, Trafton J, Efron B, Clay D, Sharifzadeh Y, Ruchelli G, Goodman S, Huddleston J, Maloney W, Dirbas F, Shrager J, Costouros J, Curtin C, Carroll I. Effect of Perioperative Gabapentin on Postoperative Pain Resolution and Opioid Cessation in a Mixed Surgical Cohort: A Randomized Clinical Trial. JAMA Surg. 2018 April 1; 153(4):303–311.Scientific Literature Review
Reviewed By: Leslie H. Pyle, DPM
Residency Program: Detroit Medical Center, Detroit, MI
Podiatric Relevance: Postoperative pain management is a huge concern for patients. However, there is increasing evidence that opioids are overprescribed following surgery. In addition, the number of opioid-related deaths and healthcare costs associated with opioid abuse has risen exponentially over the last five years. Therefore, there has been an emphasis on alternative therapies for pain management to help reduce the opioid crisis and prevent chronic opioid use. This randomized clinical trial aims to determine the effect of perioperative gabapentin on remote postoperative time to pain resolution and opioid cessation.
Methods: A randomized, double-blind, placebo-controlled trial of perioperative gabapentin was conducted at a teaching hospital. The patients were assigned to two groups. One group received perioperative gabapentin, and the other received a placebo. Lorazepam was chosen as the placebo to match the sedating effects of gabapentin. Prior to the surgery, patients completed a survey intended to identify the likelihood of the patient developing chronic pain post surgery. The study tracked adverse drug events for both groups of participants. The primary outcome studied was time to pain resolution. Secondary outcomes studied were time to opioid cessation and the proportion of participants with continued pain or opioid use at six months and one year. Patients were followed up to two years postoperatively.
Results: A total of 1,805 patients from 18 to 75 years old were screened. A total of 410 patients were analyzed with 208 assigned to receive gabapentin and 201 to receive the placebo. In regards to the primary outcome of time to pain resolution, median time to resolution was 84 days for patients receiving gabapentin and 73 days in patients receiving the placebo. In regards to the time to opioid cessation, patients receiving gabapentin had a 24 percent increase in the rate of opioid cessation after surgery. In addition, the incidence of adverse events was similar in both groups with 94.6 percent of the placebo group and 93.8 percent of the gabapentin group reporting one or more adverse events.
Conclusion: Gabapentin has emerged as a promising alternative to opioids as the need for alternative pain management drugs increases. The authors concluded that perioperative gabapentin had no effect on time to pain resolution; however, perioperative gabapentin did lead to opioid cessation. This result is extremely promising for long-term chronic pain treatment without risk of opioid dependency. If the results of this study are replicated in additional, long-term studies, gabapentin may prove a reliable pain-management tool for podiatric surgeons.