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7 In December 2019, the US Food and Drug Administration issued a warning on serious breathing difficulties associated with gabapentin and pregabalin in patients with other respiratory risk factors, including the use of opioids. Moreover, it has been reported that they can potentiate respiratory and central nervous system depression in an additive way when coadministered with opioids. However, these drugs are associated with nontrivial adverse effects, including sedation and dizziness. Their off-label use as adjuvant analgesics following surgery has been found to decrease postoperative pain and opioid consumption 4 - 6 and is increasing. Gabapentinoids (gabapentin and pregabalin) are anticonvulsant medications, commonly used for the treatment of chronic neuropathic pain. 2 While acetaminophen and NSAIDs have been coadministered with opioids for decades, the use of gabapentinoids is relatively recent. 1 - 3 In the postoperative setting, the 3 most common nonopioid pharmacologic analgesics used in multimodal pain management include acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and gabapentinoids. When effectively implemented, such strategies have been shown to improve the quality of care, decrease hospital stay, and reduce opioid use. The results were consistent across sensitivity analyses and subgroups identified by key clinical factors.Ĭonclusions and Relevance In this real-world cohort study of patients who underwent major surgery, concomitant use of gabapentinoids with opioids was associated with increased risk of opioid overdose and other opioid-related adverse events however, the absolute risk of adverse events was low.Īmid the ongoing opioid epidemic in the United States, physicians are increasingly turning to multimodal pain management strategies.
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Adjusted hazard ratios for secondary outcomes were 1.68 (95% CI, 1.59-1.78) for respiratory complications, 1.77 (95% CI, 1.61-1.93) for unspecified adverse effects of opioids, and 1.70 (95% CI, 1.62-1.79) for the composite outcome. The primary analysis yielded the adjusted hazard ratio of 1.95 (95% CI, 1.49-2.55), and the number needed to treat for an additional overdose to occur was 16 914 patients (95% CI, 11 556-31 537 patients). Following propensity score trimming, the cohort included 737 383 patients exposed to gabapentinoids and 3 002 480 patients receiving opioids only. Overall, 441 overdose events were identified, with absolute risks of 1.4 per 10 000 patients with gabapentinoid exposure and 0.7 per 10 000 patients receiving opioids only. Results Gabapentinoids with opioids were administered to 892 484 of 5 547 667 eligible admissions (16.1% mean age, 63.5 years 353 315 men). Patients were followed up for as long as 30 days from the day of surgery until deviation from the initial treatment regimen or discharge. Secondary outcomes included respiratory complications, unspecified adverse effects of opioid use, and a composite of these 3 outcomes. Main Outcomes and Measures Primary outcome was opioid overdose. Data analysis was conducted from February to April 2020.Įxposure Gabapentinoids (gabapentin or pregabalin) coadministered with opioids starting the day of surgery vs opioid therapy without gabapentinoids. Objective To evaluate the association between perioperative coadministration of gabapentinoids and opioids with inpatient opioid-related adverse events in surgical patients.ĭesign, Setting, and Participants This cohort study used propensity score trimming, stratification, and weighting of adults admitted for a major surgery between October 2007 and December 2017 who were treated with opioids on the day of surgery and included in the Premier Research database. Importance The use of gabapentinoids in multimodal postoperative analgesia is increasing however, when coadministered with opioids, these drugs may potentiate central nervous system and respiratory depression. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.