Gabapentinoids and opioids combo increases opioid overdose risk postoperatively
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. While acetaminophen and NSAIDs have been coadministered with opioids for decades, the use of gabapentinoids is relatively recent.
However, a recent study suggests concomitant use of gabapentinoids with opioids was associated with an increased risk of opioid overdose and other opioid-related adverse events. The study findings were published in the JAMA Network Open on December 29, 2020.
Gabapentinoids (gabapentin and pregabalin) are anticonvulsant medications, commonly used for the treatment of chronic neuropathic pain. Their off-label use as adjuvant analgesics following surgery has been found to decrease postoperative pain and opioid consumption and is increasing. However, 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. As the use of gabapentinoids perioperatively is increasing and the clinical data on their safety, when coadministered with opioids for postoperative analgesia, is lacking researchers conducted a population-based cohort study in a large, nationwide database of US hospital admissions to assess whether coadministration of gabapentinoids with opioids is associated with increased risk of opioid-related adverse outcomes, including opioid overdose, in surgical patients.
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