Gabapentinoids: When Is the Right Moment to Stop?

Abstract

Gabapentinoids are routinely used for postoperative acute pain management. This practice is increasing in North America, although it is offlabel and not supported by evidence.1 While the perioperative use of gabapentinoids is associated with a small decrease in opioid administration during the immediate postoperative period, their administration does not have clinically significant effect on postoperative acute, subacute and chronic pain. Potential impact of such a short-term decrease of opioid use on intermediateand long-term opioid uses after surgery remains unknown. In this issue of Anesthesia & Analgesia, Young et al2 published the results of a large multicenter observational study evaluating the association between gabapentinoid administration during the preoperative period and the prolonged postoperative opioid use among 13,958 surgical opioid naïve geriatric patients (>65 years old).2 The analyses were conducted using an appropriate log-binomial model adjusted with a propensity score based on the inverse probability of treatment weights method. Confounding variables chosen in their models were relevant and comprehensive. Results of this study showed that 21% of patients received gabapentinoids during the preoperative period with an increased rate over time from 7.4% in 2016 to 31.8% in 2019. No effect was observed on the risk of prolonged opioid use 90 days after surgery. These results were consistent in the subgroup of patients at greater risk of chronic pain. The preoperative use of gabapentinoids was shown to be increasing with age but was not associated with long-term postoperative opioid use. Although the hypothesis that gabapentinoids could potentially prevent chronic opioid use has wide support, this large-scale observational study showed otherwise. This observation is also consistent with those from a recent comprehensive systematic review.1