Gabapentin and Lyrica

[kmurp]

Perioperative Use of Gabapentinoids for the Management of Postoperative Acute Pain:A Systematic Review and Meta-analysis | Anesthesiology | ASA Publications
In this new meta-analysis in this months’ Anesthesiology, the use of these drugs is very much called into question. Will this change your practice?

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[dhb]

" No clinically significant analgesic effect for the perioperative use of gabapentinoids was observed. "

No $h.t!

Never used it so no it won't change what i do.

 

[Planktonmd]

Perioperative Use of Gabapentinoids for the Management of Postoperative Acute Pain:A Systematic Review and Meta-analysis | Anesthesiology | ASA Publications
In this new meta-analysis in this months’ Anesthesiology, the use of these drugs is very much called into question. Will this change your practice?

I never thought they worked on pain. All they do is make the patient more sedated post-op which may be perceived by us as analgesia, but can be achieved by any other sedative (benzo for example).

 

[Hoya11]

Perioperative Use of Gabapentinoids for the Management of Postoperative Acute Pain:A Systematic Review and Meta-analysis | Anesthesiology | ASA Publications
In this new meta-analysis in this months’ Anesthesiology, the use of these drugs is very much called into question. Will this change your practice?

When I was doing pain, the classic line about these drugs is that it takes 3 weeks to work, makes you tired, and you wonder why the doctor put me on this drug?

Yes I did see people that after 3 weeks - 3 months saw relief and continued, IMO about a third of those started on it.

For ACUTE Post-Surgical Pain? Does not make any sense. I am surprised the use of these drugs perioperatively became as popular as it did.

 

[deleted697535]

Perioperative Use of Gabapentinoids for the Management of Postoperative Acute Pain:A Systematic Review and Meta-analysis | Anesthesiology | ASA Publications
In this new meta-analysis in this months’ Anesthesiology, the use of these drugs is very much called into question. Will this change your practice?

finally. hate the things. leaves people with fuzzy heads in just as much pain.

 

[TheLoneWolf]

Inappropriate for postop pain. Evidence suggests no improvement in analgesia and increased risk of respiratory events for gabapentin. Still hasn't changed practice though. Where I did my pain fellowship, the acute pain service at a large tertiary hospital routinely placed nearly all postop consults on gabapentin due to it's supposed opioid sparing effect.

 

[MirrorTodd]

As far as I know, we don't make the eras protocols and the patients get the drugs before we have a chance to see them. We would have to convince the surgeons not to prescribe them. Who knows if that'll be effective...

 

[deleted126335]

" No clinically significant analgesic effect for the perioperative use of gabapentinoids was observed. "

No $h.t!

Never used it so no it won't change what i do.

I use a lot of gabapentin. Looks like it’s time for a change.

 

[coffeebythelake]

Perioperative Use of Gabapentinoids for the Management of Postoperative Acute Pain:A Systematic Review and Meta-analysis | Anesthesiology | ASA Publications
In this new meta-analysis in this months’ Anesthesiology, the use of these drugs is very much called into question. Will this change your practice?

Some (not so clinical) anesthesiologists in my dept love using it.

 

[2Fast2Des]

I do have to agree that the anticonvulsants are a bit sketch, when I rotated on chronic pain, most of not all pts felt they never worked or took forever to have any effect. If ofirmev is not effective (according to new data) and gaba is no good, then what's the next step in periop multimodal analgesia?

 

[deleted162650]

what's the next step in periop multimodal analgesia?

Opioids.

 

[TheLoneWolf]

Opioids.

I am suspect of the authors publishing that they have been giving opioid free anesthetics for years. Toradol lido and ketamine infusions are not huge game changers. Just having the patients in pain until the PACU nurses give them opioids.

A large name cancer hospital I rotated at during residency routinely did this to lower risk of " cancer recurrance" and bothered me to end. These patients wake up in a lot of pain and the PACU and floors snowed them...with opioids..to play catch up.

 

[dhb]

I am suspect of the authors publishing that they have been giving opioid free anesthetics for years.

Well i'm not an author (so no skin in the game) and my last prescriptions for intraop opiods were last year. In that time frame i've given morphine a handfull of times in PACU.
I can say with confidence that they're not very usefull (unless you are supervising 4 rooms with CRNAs).

 

[deleted162650]

Well i'm not an author (so no skin in the game) and my last prescriptions for intraop opiods were last year. In that time frame i've given morphine a handfull of times in PACU.
I can say with confidence that they're not very usefull (unless you are supervising 4 rooms with CRNAs).

I think the difference is that you take care of strong old-stock Europeans.

Doesn't work as well with whiny cry-baby p*ssy-*ss Americans.

 

[coffeebythelake]

I am suspect of the authors publishing that they have been giving opioid free anesthetics for years. Toradol lido and ketamine infusions are not huge game changers. Just having the patients in pain until the PACU nurses give them opioids.

A large name cancer hospital I rotated at during residency routinely did this to lower risk of " cancer recurrance" and bothered me to end. These patients wake up in a lot of pain and the PACU and floors snowed them...with opioids..to play catch up.

Exactly. This.

 

[deleted875186]

I never thought it was good to use gabapentin routinely, but I still
Think there’s more potential benefit than risk with giving it to someone who’s pain will be difficult to control postop.

 

[Airway]

I 'believe' in it for ponv.

The Effect of Preoperative Gabapentin on Postoperative Nausea and Vomiting: A Meta-Analysis - PubMed

Preoperative gabapentin is associated with a significant reduction in PONV among studies designed to investigate this end point. Preoperative gabapentin should be considered not only as part of a multimodal approach to postoperative analgesia, but also for prevention of PONV.

pubmed.ncbi.nlm.nih.gov

Def not for pain.

I say believe because all the ponv papers are a bit suspect.

 

[Lecithin5]

its amazing how many times the pendulum can swing in anesthesia. Opioids good, now bad. Gabapentinoids work, now they don’t. Exparel works, or does it? and so on...

 

[GassYous]

its amazing how many times the pendulum can swing in anesthesia. Opioids good, now bad. Gabapentinoids work, now they don’t. Exparel works, or does it? and so on...

I was an exparel skeptic but I have patients getting 3 days of analgesia from half exparel half bupi 0.5%.

I like preop tylenol but gabapentin is nonsense.

 

[Lecithin5]

I was an exparel skeptic but I have patients getting 3 days of analgesia from half exparel half bupi 0.5%.

I have my good moments with exparel as well and tend to use it. But if you do a *really deep* dive into the papers that purportedly demonstrate its clinical significance, there are many holes and the data just aren’t impressive and convincing. Anyway- don’t mean to hijack the thread... back to gaba gaba

 

[TheLoneWolf]

Well i'm not an author (so no skin in the game) and my last prescriptions for intraop opiods were last year. In that time frame i've given morphine a handfull of times in PACU.
I can say with confidence that they're not very usefull (unless you are supervising 4 rooms with CRNAs).

I sit my own cases. We have one person in our group who is always doing wacky infusions intraop for pain without any notable difference to everyone else.

Would like to know how you approach spine surgeries (especially cervical), multisite traumas, burns, anticoagulated elderly for emergency surgery.

On the internet everyone sounds condescending but I would like to hear your approaches and how well it works. The rest of us could learn something.

 

[dhb]

I sit my own cases. We have one person in our group who is always doing wacky infusions intraop for pain without any notable difference to everyone else.

Would like to know how you approach spine surgeries (especially cervical), multisite traumas, burns, anticoagulated elderly for emergency surgery.

On the internet everyone sounds condescending but I would like to hear your approaches and how well it works. The rest of us could learn something.

I don't do whacky infusions. I do as much of nothing as possible.
Cervical spines i do a superficial cervical block. We don't do scoliosis surgeries nor much trauma or burns.
I just don't ever give opioids at induction, do whatever block is possible and during surgery i'll give clonidine for htn, muscle relaxant if needed but mostly they cruise along just fine.

 

[coffeebythelake]

I sit my own cases. We have one person in our group who is always doing wacky infusions intraop for pain without any notable difference to everyone else.

Would like to know how you approach spine surgeries (especially cervical), multisite traumas, burns, anticoagulated elderly for emergency surgery.

On the internet everyone sounds condescending but I would like to hear your approaches and how well it works. The rest of us could learn something.

Depends on size of spine surgery but larger ones we do at least sufentanil 0.3 to 0.5 mcg/kg/hr, more if needed. Extremely painful procedures can also do ketamine or methadone for NMDA antagonist effect.