A randomized trial of nearly 1,200 patients found that perioperative gabapentin did not reduce hospital stay, opioid use, or improve pain and quality of life following major cardiac, thoracic, or abdominal surgery. The length of stay was nearly identical between patients who received gabapentin and those who were given placebo. Mortality and serious adverse events were also comparable.
The multicenter, double-blinded, placebo-controlled trial enrolled patients undergoing nonemergency major surgery at seven United Kingdom hospitals between 2018 and 2022. Patients were randomized to receive either gabapentin, 600 mg preoperatively and 300 mg twice daily for 2 postoperative days, or placebo in addition to standard multimodal analgesia. Follow-up was completed at discharge, 4 weeks, and 4 months.
Some short-term effects of gabapentin were observed. In thoracic and abdominal surgery, opioid use was slightly lower in the first 2 days among patients given gabapentin. Pain scores in the immediate hours after surgery were also modestly reduced. However, these effects did not persist, and at both 4 weeks and 4 months, more patients in the gabapentin group reported ongoing pain compared with placebo. Quality-of-life measures, including EQ-5D-5L and SF-12 scores, also showed no benefit.
“Length of stay is important, as it is reflective of all harms and benefits in the peri- and postoperative period, which are important to both patients and healthcare providers,” wrote lead study author Sarah Baos, PhD, of the University of Bristol, United Kingdom, and colleagues.
Limitations for this study included exclusion of emergency and minor surgeries, dosing regimen that may not reflect all clinical practice, and incomplete adherence to protocol dosing.
Researchers concluded that gabapentin added to multimodal analgesia and did not improve recovery outcomes. Hospital stay, overall opioid use, long-term pain, and quality-of-life were unchanged compared with placebo.
The study was supported by the United Kingdom National Institute for Health and Care Research. Several investigators reported relationships with industry. Others declared no competing interests.
Source: Anesthesiology
