Medication helps decrease opioid use following surgery

Bottom Line: Patients who received the nonopioid pain medication gabapentin before and after surgery were somewhat more likely to stop using opioids after surgery.

Why The Research Is Interesting: Millions of Americans undergo surgery each year and most are prescribed opioids for pain management. Some of these patients become chronic users of opioids.

Who and When: Patients scheduled for surgery from May 2010 to July 2014 and followed up to two years

What (Study Measures): Gabapentin before and after surgery or the active placebo lorazepam before surgery and an inactive placebo after surgery (interventions); time to pain resolution (five consecutive reports of zero on a pain scale) and time to opioid cessation (five consecutive reports of no opioid use) (outcomes); 410 patients were separated nearly evenly into gabapentin or placebo treatment groups

How (Study Design): This was a randomized clinical trial (RCT). An RCT allows for the strongest inferences to be made about the true effect of an intervention. However, not all RCT results can be replicated in real-world settings because patient characteristics or other variables may differ from those that were studied in the RCT.

Authors: Jennifer Hah, M.D., M.S., Stanford University, Palo Alto, California, and coauthors.

Results: 

• Gabapentin before and after surgery had no effect compared with placebo on time to cessation of pain.
• Patients who received gabapentin had a modest increase in opioid cessation.

Study Limitations: Physicians could prescribe different medications to different patients and this could have affected outcomes.

Study Conclusions: Routine use of gabapentin before and after surgery may be warranted if it can promote opioid cessation and prevent chronic use of opioids.

More information:
jamanetwork.com/journals/jamas … 1/jamasurg.2017.4915

Provided by The JAMA Network Journals