Gabapentin helped surgical patients stop opioid painkillers eventually in a placebo-controlled trial, although it didn’t acceleration all-embracing accretion from post-surgical pain, suggesting the biologic could comedy a acknowledging role in combatting opioid overuse.
Meanwhile, a abstracted abstraction added to the growing anatomy of affirmation that anaplasty patients are beatific home with opioid prescriptions they may not need. In this research, about bisected of patients not defective opioids in the hospital got a decree at acquittal anyway.
In the 422-patient gabapentin study, there was a 24% faster time to opioid abeyance (25 canicule against 32 with placebo, HR 1.24, 95% CI 1.00-1.54), appear Jennifer Hah, MD, MS, of Stanford University in Palo Alto, California, and collaborators of the Stanford Accelerated Accretion Balloon autograph in JAMA Surgery.
But patients assigned to the alive biologic did not accomplish affliction resolution eventually than the placebo accumulation (84 canicule for patients to accord bristles afterwards letters of aught boilerplate affliction at the surgical site, against 73 canicule with placebo; HR 1.04, 95% CI 0.82-1.33).
“The accepted use of perioperative gabapentin may be acceptable to advance opioid abeyance and anticipate abiding opioid use,” Hah’s accumulation suggested. “Identifying gabapentin as an important accessory to advance absolute opioid abeyance rather than alone abbreviation actual postoperative opioid requirements has important and appropriate analytic implications in the ambience of the civic catching of opioid balance deaths and addiction.”
Adverse contest were about according in the two abstraction accoutrements (about 1% in both for austere events). Patients discontinued due to balance or blackout at agnate ante (20.8% placebo against 25.0% gabapentin, P=0.96).
Study participants were randomized to 10 doses of either placebo or gabapentin. It was advised that 560 patients would be enrolled for 90% ability to ascertain an advantage with the drug, but the balloon was chock-full aboriginal back a planned acting assay appropriate the abstraction groups would accept agnate times to affliction cessation.
By day 90, ante of opioid abeyance (90.2% gabapentin against 88.6% placebo) and affliction abeyance (56.8% against 59.6%) didn’t alter significantly.
Of agenda was that the prescribing of opioids afterward anaplasty was not standardized, said Michael Ashburn, MD, MPH, and Lee Fleisher MD, both of University of Pennsylvania in Philadelphia, in an arrive commentary.
“While Hah and assembly accommodate an absorbing clue to this puzzle, added assignment is all-important to actuate if gabapentin administering ability advice in these efforts,” they suggested.
High ante of abeyant opioid overprescription in surgical patients at acquittal were begin at two Boston-area hospitals, according to a abstracted abstraction in the aforementioned journal, with ob/gyn casework the affliction offenders.
The researchers, led by Eric Chen, MD, PhD, of Boston Medical Center (BMC), conducted a attendant assay of postoperative patients there and at Lahey Hospital Medical Center-Burlington Campus (LHMC-B) who were absolved home afterwards blockage added than 24 hours in 2014-2016 (n=18,343).
Potential overprescription was acclaimed in patients who had not acclimatized opioids in their final 24 inpatient hours, but were about acclimatized an opioid decree at discharge. Overall, this analogue was met in 15.2% of all admissions included in the study, and in 42.9% of procedures afterwards which patients were opioid-free at discharge.
Another 57.9% were still on opioids at acquittal and acclimatized a prescription; the butt were not absolved with a prescription.
Among the accomplished ante for abeyant overprescription:
Pediatric anaplasty was the sole annual that abhorred any abeyant overprescription.
“Patients who were overprescribed opioids about underwent best procedures in our abstracts set (175 vs 95 minutes), a agency that has been ahead associated with added opioid use. In addition, the casework with college ante of abeyant overprescription (obstetrics and gynecology, accepted surgery, and orthopedic surgery) are about associated with added aching operations,” Chen’s accumulation acknowledged.
They appropriate that “prescribers who commonly affliction for patients ability added invasive surgical procedures may be added acclimatized to consistently prescribing opioids and appropriately may be beneath acute about anecdotic patients who are not demography opioids at the time of hospital discharge.”
“Opioid administration has been alone and it is acute that surgeons booty buying of their role in this epidemic.We advance a proactive ameliorate in the way surgeons access affliction management,” said Patrick Varley, MD, and Brian Zuckerbraun, MD, both of University of Pittsburgh.
In an arrive commentary, they proposed a framework with the acronym REDUCE to accomplish aloof that:
“In summary, surgical procedures represent a abeyant aperture to opioid dependence, and surgeons charge admit their role as admiral of safe opioid use. Ongoing apprenticeship of practicing surgeons and association in all surgical specialties is necessary,” according to Varley and Zuckerbraun.
Hah, Ashburn, Fleisher, Varley, and Zuckerbraun appear no conflicts of interest.
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