Gabapentinoid Use in Perioperative Care and Current Controversies.
ERAS
Gabapentin
Multimodal
Opioid epidemic
Pregabalin
Journal
Current pain and headache reports
ISSN: 1534-3081
Titre abrégé: Curr Pain Headache Rep
Pays: United States
ID NLM: 100970666
Informations de publication
Date de publication:
Feb 2022
Feb 2022
Historique:
accepted:
06
12
2021
pubmed:
28
1
2022
medline:
4
3
2022
entrez:
27
1
2022
Statut:
ppublish
Résumé
This review summarizes the risks and benefits of gabapentinoids (gabapentin and pregabalin) for perioperative pain control and the controversies surrounding their use in a variety of settings. We review current literature with the goal of providing patient-centric and procedure-specific recommendations for the use of these medications. Gabapentinoids are among the most prescribed medications in the USA, and typically for off-label indications such as postoperative pain. In the perioperative setting, multimodal analgesic or "opioid-sparing" regimens have become the standard of care-and some clinical protocols include gabapentinoids. At the same time, guidelines regarding the perioperative use of gabapentinoids are conflicting and evidence supporting their broad use is lacking. Gabapentinoids administered perioperatively reduce opioid requirements and pain scores for a variety of surgeries. The extent of opioid and pain reduction, however, is not always clinically significant. These medications reduce postoperative nausea and vomiting as well as pruritis, likely as a feature of reducing opioid intake, but are associated with side effects such as dizziness, ataxia, and cognitive dysfunction. Gabapentinoids also increase the risk of respiratory depression, in particular when paired with opioids. There is thus evidence suggesting that the routine use of these medications for perioperative pain management is not recommended. An individualized, patient- and surgery-specific approach should be used, although research is still needed to determine risks and benefits during perioperative use.
Identifiants
pubmed: 35084656
doi: 10.1007/s11916-022-01012-2
pii: 10.1007/s11916-022-01012-2
doi:
Substances chimiques
Analgesics
0
Analgesics, Opioid
0
Pregabalin
55JG375S6M
Gabapentin
6CW7F3G59X
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
139-144Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Joshi GP, Kehlet H. Enhanced Recovery Pathways: Looking Into the Future. Anesth Analg. 2019;128(1):5–7.
doi: 10.1213/ANE.0000000000003746
Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003;97(2):534–40, table of contents.
Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367(9522):1618–25.
doi: 10.1016/S0140-6736(06)68700-X
Rudd RA, Aleshire N, Zibbell JE, Gladden RM. Increases in Drug and Opioid Overdose Deaths-United States, 2000–2014. MMWR Morb Mortal Wkly Rep. 2016;64(50–51):1378–82.
doi: 10.15585/mmwr.mm6450a3
Karamchandani K, Pyati S, Bryan W, et al. New Persistent Opioid Use After Postoperative Intensive Care in US Veterans. JAMA Surg. 2019;154(8):778–80.
doi: 10.1001/jamasurg.2019.0899
Benyamin R, Trescot AM, Datta S, et al. Opioid complications and side effects. Pain Physician. 2008;11(2 Suppl):S105–20.
doi: 10.36076/ppj.2008/11/S105
Ivraj NK, Raghavji F, Bethell J, et al. Persistent Postoperative Opioid Use: A Systematic Literature Search of Definitions and Population-based Cohort Study. Anesthesiology. 2020;132(6):1528–39.
Rose MA, Kam PCA. Gabapentin: pharmacology and its use in pain management. Anaesthesia. 2002;57(5):451–62.
doi: 10.1046/j.0003-2409.2001.02399.x
Kremer M, Salvat E, Muller A, Yalcin I, Barrot M. Antidepressants and gabapentinoids in neuropathic pain: Mechanistic insights. Neuroscience. 2016;338:183–206.
doi: 10.1016/j.neuroscience.2016.06.057
FDA: Approved Labeling: Gabapentin. Published online 2011. Food and Drug Administration. Accessed 20 Jun 2021. https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/020235s036,020882s022,021129s022lbl.pdf .
FDA: Full prescribing information: Pregabalin. Published online 2012. Food and Drug Administration. Accessed 20 Jun 2021. https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/021446s028lbl.pdf .
Hamer AM, Haxby DG, McFarland BH, Ketchum K. Gabapentin use in a managed medicaid population. J Manag Care Pharm. 2002;8(4):266–71.
doi: 10.18553/jmcp.2002.8.4.266
Goodman CW, Brett AS. Gabapentin and Pregabalin for Pain - Is Increased Prescribing a Cause for Concern? N Engl J Med. 2017;377(5):411–4.
doi: 10.1056/NEJMp1704633
QuintilesIMS Institute. Medicines Use and Spending in the U.S.: A Review of 2016 and Outlook to 2021 [Internet]. Parsippany, NJ; 2017. https://structurecms-staging-psyclone.netdna-ssl.com/client_assets/dwonk/media/attachments/590c/6aa0/6970/2d2d/4182/0000/590c6aa069702d2d41820000.pdf?1493985952 .
Chou R, Gordon DB, de Leon-Casasola OA, et al. Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016;17(2):131–57.
doi: 10.1016/j.jpain.2015.12.008
Tiippana EM, Hamunen K, Kontinen VK, Kalso E. Do surgical patients benefit from perioperative gabapentin/pregabalin? A systematic review of efficacy and safety. Anesth Analg. 2007;104(6):1545–56.
doi: 10.1213/01.ane.0000261517.27532.80
Peng PW, Wijeysundera DN, Li CC. Use of gabapentin for perioperative pain control – a meta-analysis. Pain Res Manag. 2007;12(2):85–92.
doi: 10.1155/2007/840572
Schmidt PC, Ruchelli G, Mackey SC, Carroll IR. Perioperative gabapentinoids: choice of agent, dose, timing, and effects on chronic postsurgical pain. Anesthesiology. 2013;119(5):1215–21.
doi: 10.1097/ALN.0b013e3182a9a896
Doleman B, Heinink TP, Read DJ, Faleiro RJ, Lund JN, Williams JP. A systematic review and meta-regression analysis of prophylactic gabapentin for postoperative pain. Anaesthesia. 2015;70(10):1186–204.
doi: 10.1111/anae.13179
Mishriky BM, Waldron NH, Habib AS. Impact of pregabalin on acute and persistent postoperative pain: a systematic review and meta-analysis. Br J Anaesth. 2015;114(1):10–31.
doi: 10.1093/bja/aeu293
Liu B, Liu R, Wang L. A meta-analysis of the preoperative use of gabapentinoids for the treatment of acute postoperative pain following spinal surgery. Medicine (Baltimore). 2017;96(37):e8031.
Eipe N, Penning J, Yazdi F, et al. Perioperative use of pregabalin for acute pain-a systematic review and meta-analysis. Pain. 2015;156(7):1284–300.
doi: 10.1097/j.pain.0000000000000173
The European Society of Regional Anaesthesia and Pain Therapy: Prospect. PROSPECT collaborative. Accessed 20 Jan 2022. https://esraeurope.org/prospect .
Verret M, Lauzier F, Zarychanski R, et al. Perioperative Use of Gabapentinoids for the Management of Postoperative Acute Pain: A Systematic Review and Meta-analysis. Anesthesiology. 2020;133(2):265–79. https://doi.org/10.1097/ALN.0000000000003428 .
doi: 10.1097/ALN.0000000000003428
pubmed: 32667154
Hah J, Mackey SC, Schmidt P, McCue R, Humphreys K, Trafton J, Efron B, Clay D. SharifzadehY, Ruchelli G, Goodman S, Huddleston J, Maloney WJ, Dirbas FM, 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. 2017;13:13.
Urits I, Lavin C, Patel M, Maganty N, Jacobson X, Ngo AL, Urman RD, Kaye AD, Viswanath O. Chronic pain following cosmetic breast surgery: a comprehensive review. Pain Ther. 2020;9(1):71–82. https://doi.org/10.1007/s40122-020-00150-y . Epub 2020 Jan 28 PMID: 31994018.
doi: 10.1007/s40122-020-00150-y
pubmed: 31994018
pmcid: 7203369
Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367(9522):1618–25.
doi: 10.1016/S0140-6736(06)68700-X
Chaparro LE, Smith SA, Moore RA, Wiffen PJ, Gilron I. Pharmacotherapy for the prevention of chronic pain after surgery in adults. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No. CD008307.
Clarke H, Bonin RP, Orser BA, Englesakis M, Wijeysundera DN, Katz J. The prevention of chronic postsurgical pain using gabapentin and pregabalin: a combined systematic review and meta-analysis. Anesth Analg. 2012;115(2):428–42.
doi: 10.1213/ANE.0b013e318249d36e
Rai AS, Khan JS, Dhaliwal J, Busse JW, Choi S, Devereaux PJ, Clarke H. Preoperative pregabalin or gabapentin for acute and chronic postoperative pain among patients undergoing breast cancer surgery: A systematic review and meta-analysis of randomized controlled trials. J Plast Reconstr Aesthet Surg. 2017;70(10):1317–28.
doi: 10.1016/j.bjps.2017.05.054
Anwar S, Cooper J, Rahman J, Sharma C, Langford R. Prolonged Perioperative Use of Pregabalin and Ketamine to Prevent Persistent Pain after Cardiac Surgery. Anesthesiology. 2019;131(1):119–31.
doi: 10.1097/ALN.0000000000002751
Mishriky BM, Waldron NH, Habib AS. Impact of pregabalin on acute and persistent postoperative pain: a systematic review and meta-analysis. Br J Anaesth. 2015;114(1):10–31.
doi: 10.1093/bja/aeu293
Kharasch ED, Clark JD, Kheterpal S. Perioperative Gabapentinoids: Deflating the Bubble. Anesthesiology. 2020;133(2):251–4.
doi: 10.1097/ALN.0000000000003394
Ohnuma T, Krishnamoorthy V, Ellis AR, et al. Association ’Between Gabapentinoids on the Day of Colorectal Surgery and Adverse Postoperative Respiratory Outcomes. Ann Surg. 2019;270(6):e65–7.
doi: 10.1097/SLA.0000000000003317
Cavalcante AN, Sprung J, Schroeder DR, Weingarten TN. Multimodal analgesic therapy with gabapentin and its association with postoperative respiratory depression. Anesth Analg. 2017;125:141.
doi: 10.1213/ANE.0000000000001719
Weingarten TN, Jacob AK, Njathi CW, Wilson GA, Sprung J. Multimodal Analgesic Protocol and Postanesthesia Respiratory Depression During Phase I Recovery After Total Joint Arthroplasty. Reg Anesth Pain Med. 2015;40(4):330–6.
doi: 10.1097/AAP.0000000000000257
Deljou A, Hedrick SJ, Portner ER, Schroeder DR, Hooten WM, Sprung J, Weingarten TN. Pattern of perioperative gabapentinoid use and risk for postoperative naloxone administration. Br J Anaesth. 2018;120(4):798–806.
doi: 10.1016/j.bja.2017.11.113
Zhou L, Bhattacharjee S, Kwoh CK, Tighe PJ, Malone DC, Slack M, Wilson DL, Brown JD, Lo-Ciganic WH. Trends, Patient and Prescriber Characteristics in Gabapentinoid Use in a Sample of United States Ambulatory Care Visits from 2003 to 2016. J Clin Med. 2019;9(1):83.
doi: 10.3390/jcm9010083
Gomes T, Juurlink DN, Antoniou T, Mamdani MM, Paterson JM, van den Brink W. Gabapentin, opioids, and the risk of opioid-related death: A population-based nested case-control study. PLoS Med. 2017;14(10):e1002396. https://doi.org/10.1371/journal.pmed.1002396 .
FDA in Brief: FDA requires new warnings for gabapentinoids about risk of respiratory depression. Food and Drug Administration. Accessed 20 Jun 2021. www.fda.gov/news-events/fda-brief/fda-brief-fda-requires-new-warnings-gabapentinoids-about-risk-respiratory-depression .
FDA warns about serious breathing problems with seizure and nerve pain medicines gabapentin (Neurontin, Gralise, Horizant) and pregabalin (Lyrica, Lyrica CR). Food and Drug Administration. Accessed 20 Jun 2021. www.fda.gov/drugs/drug-safety-and-availability/fda-warns-about-serious-breathing-problems-seizure-and-nerve-pain-medicines-gabapentin-neurontin .
Drug Enforcement Administration, Department of Justice. Schedules of controlled substances: placement of pregabalin into schedule V. Final rule. Fed Regist. 2005;70(144):43633–5.
Drug Schedules Monitored [Internet]. Prescription Drug Monitoring Program Training and Technical Assistance Program. Cited 19 Nov 2018. Available at: www.pdmpassist.org/content/drug-schedules-monitored?order=field_if_other_drugs_value&sort=desc . Accessed.
New York State Senate. Bill S8145A: Classifies gabapentin as a controlled substance. 2017–2018 Legislative Session. 6 Apr 2018.
Smith RV, Havens JR, Walsh SL. Gabapentin misuse, abuse and diversion: a systematic review. Addiction. 2016;111(7):1160–74. https://doi.org/10.1111/add.13324 .
doi: 10.1111/add.13324
pubmed: 27265421
pmcid: 5573873
Evoy KE, Sadrameli S, Contreras J, Covvey JR, Peckham AM, Morrison MD. Abuse and Misuse of Pregabalin and Gabapentin: A Systematic Review Update. Drugs. 2021;81(1):125–56.
doi: 10.1007/s40265-020-01432-7
Stenberg E, Dos Reis Falcão LF, O'Kane M, Liem R, Pournaras DJ, Salminen P, Urman RD, Wadhwa A, Gustafsson UO, Thorell A. Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations: A 2021 Update. World J Surg. 2022 Jan 4. https://doi.org/10.1007/s00268-021-06394-9 . Epub ahead of print. PMID: 34984504.
Peden CJ, Aggarwal G, Aitken RJ, Anderson ID, Bang Foss N, Cooper Z, Dhesi JK, French WB, Grant MC, Hammarqvist F, Hare SP, Havens JM, Holena DN, Hübner M, Kim JS, Lees NP, Ljungqvist O, Lobo DN, Mohseni S, Ordoñez CA, Quiney N, Urman RD, Wick E, Wu CL, Young-Fadok T, Scott M. Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS) Society Recommendations: Part 1-Preoperative: Diagnosis, Rapid Assessment and Optimization. World J Surg. 2021;45(5):1272–90. https://doi.org/10.1007/s00268-021-05994-9 . Epub 2021 Mar 6 PMID: 33677649.
doi: 10.1007/s00268-021-05994-9
pubmed: 33677649
pmcid: 8026421
Beverly A, Kaye AD, Ljungqvist O, Urman RD. Essential elements of multimodal analgesia in enhanced recovery after surgery (ERAS) guidelines. Anesthesiol Clin. 2017;35(2):e115–43. https://doi.org/10.1016/j.anclin.2017.01.018 . PMID: 28526156.
doi: 10.1016/j.anclin.2017.01.018
pubmed: 28526156