Summary: So that to counter the opioid epidemic, it is vital to reduce their use. One of the effective approaches is using combining different pain relief methods more frequently, along with better patient counseling. The new study shows that using gabapentin for pain management may be one of the effective ways of reducing opioid use in post-surgical patients.
Undoubtedly, opioids are quite good for pain relief, at least in the short run. However, the opioid epidemic shows that what is good in the short term is not essentially good in the long run.
Widespread opioid use has fueled the opioid epidemic, resulting in the loss of millions of lives. Hence, doctors and researchers are looking for safer options. They are looking for other ways to manage severe pains, like postoperative pains, safely without exposing individuals to opioids.
Apart from non-steroid anti-inflammatory drugs (NSAIDs), many other medications can help reduce pain sensation, like antianxiety drugs, some antidepressants, certain sedatives, and even some anti-seizure drugs.
Gabapentin Seems to Be Effective Addon Drug for Pain Control in Post-Surgical Patients
In order to combat the opioid epidemic or reduce its use, Enhanced Recovery After Surgery (ERAS) protocols have been developed. This approach advocates multimodal analgesia, which combines different pain relief methods.
Several methods have been suggested to reduce opioid use after surgery, including personalized opioid dosages, gabapantinoids, and clonidine as a backup painkiller. However, the effectiveness of these methods in major surgeries like abdominal surgeries has not been well studied until now.
This latest study published by JAMA Network Open looked at data from patients who had major abdominal surgery at Ersta Hospital in Stockholm, Sweden, between 2016 and 2019. The hospital implemented a care bundle aimed at reducing opioid use post-surgery. This bundle included personalized opioid regimens, regular gabapantinoids, and clonidine as a rescue analgesic.
The Study results showed that the use of the care bundle significantly reduced the amount of opioids administered post-surgery. From 2016 to 2019, the median opioid use dropped from 75 MME to 22 MME. The proportion of patients who did not use any opioids increased from 11% to 31%, and those using low doses (≤45 MME) increased from 35% to 66%.
Regular gabapantinoids were the most effective in reducing opioid use, with only a small number of patients discontinuing due to mild adverse effects. The individualized opioid regimen also contributed to the decrease, likely because it better-matched patients’ actual needs. Clonidine, however, was associated with increased opioid consumption, possibly indicating that patients needing clonidine also required more opioids.
The study concluded that the care bundle was effective in reducing opioid use after major colorectal surgery. It suggests that gabapentin and personalized opioid regimens should be further explored as part of multimodal, opioid-free postoperative pain management strategies. Despite some limitations, such as the retrospective design and unmeasured factors, the study provides valuable insights into reducing opioid reliance in surgical recovery.
The Bottom Line
Of course, gabapentin is not a panacea, and using multiple drugs is not a new approach. Nonetheless, this study shows that one can use other non-addictive medications to reduce opioid use in clinical practice. It further indicates that some drugs are a better choice than others. For example, gabapentin is much better than clonidine.
Further, it is worth understanding that though opioids might be good for pain control, they also prolong hospital stays. Those who are prescribed opioids are also more likely to complain about chronic pains. Hence, using other medications in place of opioids has few other benefits, too. The study also highlighted the importance of patient counseling, which may further help reduce the need for painkillers.
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
