Opioid-Sparing Anesthesia: Gabapentin and Postoperative Pain

Ladich, Elaine M.; Zhou, Kelly Q; Spence, Dennis; Moore, Chad

doi:10.1016/j.jopan.2022.04.008

Cited by 7 publications

(5 citation statements)

References 10 publications

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“…For example, an orderable for oral acetaminophen/hydrocodone would be specified for pain scale 1 to 5 while an orderable for IV morphine was reserved for pain scale 6 to 10. Additionally, nonopioid pharmacologic alternatives 21-25 like NSAIDs, acetaminophen, tramadol, gabapentin, tapentadol, and nerve block agents (bupivacaine, ropivacaine) were included in the revised PowerPlans at WCH. Based on patient’s perceived pain intensity, these agents fully or partially substituted opioids as the choice of drug for pain management prescribed by providers.…”

Section: Discussionmentioning

confidence: 99%

Trends of Opioid Usage in Surgical Patients in a Small Community Hospital: Analysis of Patient Data Between 2017 and 2021

Leopold,

Gerschutz,

Rao

2023

Hosp Pharm

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Purpose: The purpose of our study was to quantify and analyze the annual opioid usage in surgical patients at Wood County Hospital (WCH) between 2017 and 2021. Methods: In this retrospective study, patient data between 2017 and 2021 was analyzed to determine the oral morphine milligram equivalent (MME) of opioids used in surgical patients at WCH. Annual MME prescribed per admission was compared each year using one-way ANOVA followed by Tukey post hoc test. Similarly, the annual use of intravenous (IV) acetaminophen for surgical patients per admission was also calculated and analyzed using the one-way ANOVA followed by Tukey post hoc test. Results: Compared to the year 2017 (42.0 ± 3.6), a statistically significant decrease in opioid usage per surgical admission (mean±SEM of MME) was observed during the years 2018 (32.6 ± 1.4; P = .04), 2019 (30.4 ± 1.2; P = .01), and 2021 (30.8 ± 1.9; P = .01). An analysis of individual opioid use revealed a trend toward lower fentanyl and hydromorphone usage each year since 2017. A significant decrease in the annual morphine usage (mean±SEM of MME) for surgical patients was observed during both 2020 (14.4 ± 0.9; P = .05) and 2021 (14.0 ± 0.7; P = .05) compared to the year 2017 (22.1 ± 2.4). Finally, compared to the year 2017, a statistically significant decrease ( P < .05) in the annual use of oxycodone (MME) and IV acetaminophen (mg) for pain management in surgical patients was observed from 2018 to 2021. Conclusion: Our analysis reveals a significant decrease in opioid usage per surgical admission at WCH over 2017 to 2021 indicating a positive impact of the various opioid stewardship measures implemented at the hospital.

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Section: Discussionmentioning

confidence: 99%

Trends of Opioid Usage in Surgical Patients in a Small Community Hospital: Analysis of Patient Data Between 2017 and 2021

Leopold,

Gerschutz,

Rao

2023

Hosp Pharm

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“…Other medications including topiramate, gabapentin, and disulfiram should also be considered. Gabapentin may provide additional benefits in this patient population due to its analgesic properties and lead to a reduction in opioid use 56 …”

Section: Treatment Of Aud In Special Populationsmentioning

confidence: 99%

“…Gabapentin may provide additional benefits in this patient population due to its analgesic properties and lead to a reduction in opioid use. 56 Naltrexone may be considered after abstaining from opioids for 7-14 days (depending on the half-life of the specific opioid). Patients should be educated about the risk of precipitating opioid withdrawal if naltrexone and opioids are used together.…”

Section: Patients On Prescription Opioid Medicationsmentioning

confidence: 99%

Medication treatment for alcohol use disorder in special populations

et al. 2023

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Background and ObjectivesAlcohol use disorder (AUD) is a significant public health concern, with underutilized effective treatments, particularly in special populations. This article summarizes the current evidence and guidelines for treating AUD in special populations.MethodsThis article is a literature review that synthesizes the latest research on AUD treatment for special populations. We screened 242 articles and included 57 in our final review.ResultsThere are four food and Drug Administration‐approved medications for AUD (MAUD): disulfiram, oral naltrexone, extended‐release injectable naltrexone (XR‐NTX), and acamprosate. Naltrexone and disulfiram have the potential to cause liver toxicity, and acamprosate should be avoided in patients with severe kidney disease. Psychosocial treatments should be considered first‐line for pregnant and nursing patients. Naltrexone is contraindicated in patients on opioids, as it may precipitate acute withdrawal. For patients experiencing homelessness, nonabstinent treatment goals may be more practical, and XR‐NTX should be considered to improve adherence. Limited evidence suggests medication can improve AUD treatment outcomes in adolescents and young adults. For patients with poor treatment response despite adequate medication adherence, switching to a different medication and augmentation with psychosocial treatments should be considered.Discussion and ConclusionsUnderstanding the unique considerations for special populations with AUD is crucial, and addressing their special needs may improve their treatment outcomes.Scientific SignificanceOur study significantly contributes to the existing literature by summarizing crucial information for the treatment of AUD in special populations, highlighting distinct challenges, and emphasizing tailored approaches to improve overall health and well‐being.

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“…4,5 In the hospital setting gabapentinoids are increasingly being used for pain management, especially post-surgery to reduce opioid consumption and increase patient satisfaction. [6][7][8] Gabapentinoids are generally perceived as relatively low-risk medications for most patients and are typically well-tolerated. 9,10 Single-substance gabapentinoid overdoses often cause sedation and nausea, but are rarely fatal.…”

Section: Introductionmentioning

confidence: 99%

Association of Gabapentinoids With Opioid-Related Overdose in the Inpatient Setting: A Single Center Retrospective Case-Control Study

Humpert,

Reveles,

Bhakta

et al. 2023

Hosp Pharm

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Objectives: Recent data suggest concomitant gabapentinoid use increases opioid-related overdose (ORO) risk; however, this association has not been well studied in the hospital setting. The primary objective of this study was to compare ORO risk, indicated by naloxone administration, in patients receiving opioids plus gabapentinoids versus opioids alone. Methods: In this retrospective case-control study of adults admitted to a large community hospital from 1/1/20 to 12/31/21, all cases (defined as patients who received naloxone more than 24 hours after admission) identified were matched 1:1 to randomly selected controls (defined as patients on opioids who did not receive naloxone). The primary outcome was the percentage of cases and controls with concomitant inpatient gabapentinoid use. Logistic regression was performed to determine the independent association between gabapentinoids and ORO (as evidenced by inpatient naloxone administration). Results: Baseline characteristics were similar between the 144 cases and 144 controls. Gabapentinoid exposure was greater for cases than controls (34.0%vs 20.8%, P = .0118). Median hospital length of stay (11vs 4 days, P < .0001) and mortality (19%vs 5%; P = .0018) were also higher for cases. In logistic regression analysis, ORO (adjusted OR 4.91; 95% CI 1.86-12.96) and serotonergic medication exposure (adjusted OR 4.31; 95% CI 1.50-12.38) were significantly associated with gabapentinoid use. Conclusions: Concomitant gabapentinoid use with opioids was associated with increased ORO risk in the inpatient setting. When considering prescribing gabapentinoids in conjunction with opioids in the hospital setting, potential benefits should be weighed against increased overdose risk.

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Opioid-Sparing Anesthesia: Gabapentin and Postoperative Pain

Cited by 7 publications

References 10 publications

Trends of Opioid Usage in Surgical Patients in a Small Community Hospital: Analysis of Patient Data Between 2017 and 2021

Trends of Opioid Usage in Surgical Patients in a Small Community Hospital: Analysis of Patient Data Between 2017 and 2021

Medication treatment for alcohol use disorder in special populations

Association of Gabapentinoids With Opioid-Related Overdose in the Inpatient Setting: A Single Center Retrospective Case-Control Study

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