Summary: A new study shows that gabapentin for pain management may be one of the effective ways to cut opioid use after surgery. To fight the opioid crisis, we must use fewer opioids. One good way is to mix pain relief methods more often. Better talks with patients help too.
No doubt, opioids are good for pain relief, at least in the short run. But the opioid epidemic shows that what is good in the short term is not always good in the long run.
Heavy opioid use fueled the opioid crisis and cost millions of lives. So doctors and researchers want safer options. They want other ways to treat severe pain, like pain after surgery, without opioids.
Besides NSAIDs (non-steroidal anti-inflammatory drugs), many other drugs can dull pain. Some calm anxiety. Some treat depression. Some are sedatives. And some are even anti-seizure drugs.
Does gabapentin reduce opioid use after surgery?
To fight the opioid crisis, experts built Enhanced Recovery After Surgery (ERAS) plans. These plans use multimodal analgesia. That means mixing different ways to ease pain.
Experts have suggested ways to use fewer opioids after surgery. One is an opioid dose fitted to each patient. Another is gabapentin-type drugs (gabapentinoids). A third is clonidine as a backup painkiller. But until now, few studies tested these after major surgery, like belly surgery.
This new study was published in JAMA Network Open . It looked at patients who had major belly surgery at Ersta Hospital in Stockholm, Sweden, between 2016 and 2019. The hospital used a care bundle to cut opioid use after surgery. The bundle had three parts: an opioid plan fitted to each patient, regular gabapentinoids, and clonidine as a rescue painkiller.
The care bundle significantly cut the amount of opioids given after surgery. From 2016 to 2019, median opioid use fell from 75 MME to 22 MME. The share of patients who used no opioids at all rose from 11% to 31%. The share using low doses (≤45 MME) rose from 35% to 66%.
Regular gabapentinoids did the most to cut opioid use. Only a few patients stopped them because of mild side effects. The opioid plan fitted to each patient also helped, likely because it better matched what patients actually needed. Clonidine, though, was linked to more opioid use. That may mean the patients who needed clonidine also needed more opioids.
The study concluded that the care bundle cut opioid use after major colon and rectal surgery. It suggests that gabapentin and opioid plans fitted to each patient deserve more study. They could be part of mixed, opioid-free pain plans after surgery. The study had limits. It was retrospective (it looked back at old records), and some factors were not measured. Still, it gives useful insight into cutting reliance on opioids during recovery from surgery.
Why use non-opioid medicines for pain after surgery?
Of course, gabapentin is not a cure-all, and using several drugs is not new. But this study shows that doctors can use other, non-addictive drugs to cut opioid use. It also suggests some drugs are better choices than others. For example, gabapentin is much better than clonidine.
Also, opioids may control pain, but they also make hospital stays longer. People given opioids are also more likely to report chronic pain. So using other drugs instead of opioids has more benefits, too. The study also showed that counseling patients matters. It may further cut the need for painkillers.
Frequently asked questions
Why was I given gabapentin after surgery?
Gabapentin is an anti-seizure drug. It is given after surgery so you need less opioid. In the Stockholm study of major belly surgery, regular gabapentinoids did more than any other part of the care bundle to cut opioid use. Only a few patients stopped them, because of mild side effects.
What are some common pain medications prescribed after surgery?
Opioids still give strong short-term relief. But modern recovery plans mix several types of drugs, so patients need fewer opioids. The options include NSAIDs, gabapentin and other anti-seizure drugs, some antidepressants, drugs for anxiety, some sedatives, and clonidine as a backup painkiller. The opioid dose itself can also be fitted to what each patient truly needs.
How do you get rid of pain after surgery?
The main approach is multimodal analgesia: mixing several ways to ease pain instead of leaning on one drug. Enhanced Recovery After Surgery (ERAS) plans are built on it. In the Stockholm study, the bundle used a fitted opioid plan and regular gabapentinoids. It dropped median opioid use from 75 to 22 MME. Talking with patients can cut the need for painkillers even more.
Source:
Gedda, C., Nygren, J., Garpenbeck, A., Hoffström, L., Thorell, A., & Soop, M. (2023). Multimodal Analgesia Bundle and Postoperative Opioid Use Among Patients Undergoing Colorectal Surgery. JAMA Network Open, 6(9), e2332408. https://doi.org/10.1001/jamanetworkopen.2023.32408
Dr. Gurpreet Singh Padda, MD, MBA, MHP
