Gabapentinoids use for alleviating postoperative pain on the rise: JAMA

A new study by Tasce Bongiovanni and team showed that the number of new postoperative gabapentinoid prescriptions rose without a subsequent decline in the percentage of patients getting postoperative opioids. The findings of this study were published in the Journal of American Medical Association.

With the aim of minimizing opioid use in the postoperative phase, guidelines from several pain societies have urged surgeons to use multimodal pain regimes, including by using gabapentinoids. By analyzing nationally representative Medicare data, this study sought to expand our understanding of variance by surgical technique by describing patterns in postoperative prescribing of both gabapentinoids and opioids following a range of surgical procedures.

A 20% US Medicare sample was employed in this serial cross-sectional analysis of gabapentinoid prescriptions from January 1, 2013, to December 31, 2018. Patients 66 years of age or older undergoing one of the 14 typical non cataract surgical procedures were included if they were gabapentinoid-naive. Data from April 2022 to April 2023 were examined. The primary outcomes were the rate of postoperative prescribing of opioids and gabapentinoids, which was defined as a prescription filled between 7 days prior to the operation and 7 days following discharge from surgery. In the postoperative phase, it was also evaluated if gabapentinoids and opioids were prescribed together.

The key findings of this study were:

In all, 494 922 patients made up the research cohort, with a mean (SD) age of 73.7 (5.9) years, 53.9% of them being women and 86.0% of them being White.

In the postoperative phase, a new gabapentinoid prescription was written for a total of 18 095 patients (3.7%). 10 956 (60.5%) women and 15 529 (85.8%) White people received new gabapentinoid prescriptions.

After accounting for each year's surgery type, age, sex, race, and ethnicity, the rate of new postoperative gabapentinoid prescriptions increased from 2.3% to 5.2% (P.001) in each case.

While there were differences in the types of operations, practically all procedures experienced an increase in the prescription of both gabapentine and opioids.

Prescriptions for opioids went up throughout this time, from 56% to 59%. Furthermore, concurrent prescription rose from 1.6% in 2014 to 4.1% in 2018 as well.

Reference:

Bongiovanni, T., Gan, S., Finlayson, E., Ross, J. S., Harrison, J. D., Boscardin, W. J., & Steinman, M. A. (2023). Trends in the Use of Gabapentinoids and Opioids in the Postoperative Period Among Older Adults. In JAMA Network Open. American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2023.18626