Gabapentin in the operating room: clear for discharge?

摘要

Most prescriptions for gabapentin are written for off label conditions-perhaps 90% by some estimates.1 Gabapentin is FDA-approved only for treatment of postherpetic neuralgia and adjunctive therapy for partial seizures. However, there is good evidence for its use in the treatment of chronic pain. There are large, well-designed, placebo-controlled, randomized trials demonstrating analgesic effects for chronic neuropathic pain including diabetic neuropathy.2 There is now evidence for the benefit of gabapentin in a new clinical context, the acute perioperative setting. In this issue of Neurology, Leung et al. lay the foundation for further widening of gabapentin's indications.Severity of postoperative pain and its treatment with opioids is commonly associated with postoperative delirium: as high as 60% after noncardiac surgery.4'5 The incidence is higher in older patients. Level of pain intensity and method of postoperative pain management increase the risk of postoperative delirium more than baseline demographics, cognition, functional status, alcohol intake, or depression.5 The mechanisms of postoperative delirium are not well understood, but this complication is clearly a class effect shared by different opioid medications.6 The challenge of managing opioid complications such as delirium is complicated by the increasing shift toward ambulatory surgery.