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Perioperative Gabapentin for pain management among elderly increases risk of delirium, complications: JAMA

Written By : Dr. Shravani Dali |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2022-09-29T20:00:12+05:30  |  Updated On 29 Sept 2022 8:00 PM IST
Perioperative Gabapentin for pain management among elderly increases risk of delirium, complications: JAMA
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Researchers have found in a new study that perioperative gabapentin use was associated with an increased risk of delirium, new antipsychotic use, and pneumonia among older patients after major surgery. Therefore careful risk-benefit assessment is needed before prescribing gabapentin for perioperative pain management to older patients suggests a recent study published in the JAMA Internal Medicine.

Gabapentin has been increasingly used as part of a multimodal analgesia regimen to reduce opioid use in perioperative pain management. However, the safety of perioperative gabapentin use among older patients remains uncertain.

A study was conducted to examine in-hospital adverse clinical events associated with perioperative gabapentin use among older patients undergoing major surgery.

This retrospective cohort study using data from the Premier Healthcare Database included patients aged 65 years or older who underwent major surgery at US hospitals within 7 days of hospital admission from January 1, 2009, to March 31, 2018, and did not use gabapentin before surgery. Data were analyzed from June 14, 2021, to May 23, 2022.

The primary outcome was delirium, identified using diagnosis codes, and secondary outcomes were new antipsychotic use, pneumonia, and in-hospital death between postoperative day 3 and hospital discharge. To reduce confounding, 1:1 propensity score matching was performed. Risk ratios (RRs) and risk differences (RDs) with 95% CIs were estimated.

Results:

  • Among 967 547 patients before propensity score matching, the rate of perioperative gabapentin use was 12.3%
  • After propensity score matching, 237 872 gabapentin users and nonusers were identified.
  • Compared with nonusers, gabapentin users had an increased risk of delirium new antipsychotic use and pneumonia, but there was no difference in in-hospital death
  • The risk of delirium among gabapentin users was greater in subgroups with high comorbidity burden than in those with low comorbidity burden and chronic kidney disease

Thus, in this cohort study, perioperative gabapentin use was associated with an increased risk of delirium, new antipsychotic use, and pneumonia among older patients after major surgery. These results suggest careful risk-benefit assessment before prescribing gabapentin for perioperative pain management.

Reference:

Park CM, Inouye SK, Marcantonio ER, et al. Perioperative Gabapentin Use and In-Hospital Adverse Clinical Events Among Older Adults After Major Surgery. JAMA Intern Med. Published online September 19, 2022. doi:10.1001/jamainternmed.2022.3680



Perioperative GabapentinOlder AdultsMajor SurgeryJAMA Intern Med
Source : JAMA Internal Medicine
Dr. Shravani Dali
Dr. Shravani Dali

    Dr. Shravani Dali has completed her BDS from Pravara institute of medical sciences, loni. Following which she extensively worked in the healthcare sector for 2+ years. She has been actively involved in writing blogs in field of health and wellness. Currently she is pursuing her Masters of public health-health administration from Tata institute of social sciences. She can be contacted at editorial@medicaldialogues.in.

    Dr. Kamal Kant Kohli
    Dr. Kamal Kant Kohli

    Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

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