Individualized opioid regimen, gabapentin lessens opioid use after colorectal surgery
Click Here to Manage Email Alerts
Key takeaways:
- Median opioid usage decreased from 75 morphine milligram equivalents to 22 MME from 2016 to 2019.
- During the same time period, the proportion of those who did not consume any opioids increased from 11% to 31%.
A postoperative care bundle that includes an individualized opioid regimen, gabapentin and clonidine as a rescue analgesic may reduce the need for opioid analgesia after major colorectal surgery, according to data in JAMA Network Open.
“In addition to addiction, opioids have adverse effects that impair recovery after surgery, such as impaired gastrointestinal motility and impaired mobilization,” Claes Gedda, MD, of the department of surgery and anesthesiology at Ersta Hospital in Stockholm, and colleagues wrote. “Multimodal analgesia is an approach in which several analgesics are combined to maximize analgesia while minimizing their adverse effects.”
They continued, “Additional methods have been proposed to reduce the need for opioids in postoperative pain control. Those include individualized opioid dosages, gabapentinoids as a baseline analgesic and clonidine as a rescue analgesic. However, the opioid-sparing effects of these methods have not yet been well evaluated in major abdominal surgery.”
In a single-center, retrospective cohort study, Gedda and colleagues evaluated whether these opioid-sparing interventions would affect postoperative opioid use among 842 patients (mean age, 64.6 years; 50% men) who underwent major colorectal surgery between January 2016 and December 2019. All patients received the following care bundle:
- An individualized opioid regimen, in which a standard order set of oral oxycodone 10 mg and naloxone 5 mg twice daily was replaced with oral oxycodone 5 mg on demand until pain was relieved.
- Oral gabapentin 300 mg twice on the day of surgery followed by 300 mg three times daily from day 1 until 7 to 10 days after surgery.
- A single dose of IV clonidine 75 mg, given on-demand for rescue pain relief instead of opioids.
The primary outcome was the quantity of opioids administered on the day of surgery and in the first 5 postoperative days, measured by morphine milligram equivalents (MME) as defined by the CDC.
During the study period, use of the three components in the care bundle increased, with individualized opioids increasing from 0% to 100%, regular gabapentin from 28% to 93% and clonidine rescue from 18% to 43%.
Median opioid usage decreased from 75 MME in 2016 to 22 MME in 2019, and the proportion of those who received low doses (≤ 45 MME) postoperatively increased from 35% to 66%. Additionally, the proportion of patients who did not consume any opioids during this time gradually increased from 11% to 31%.
Further, multivariable analysis showed an individualized opioid strategy (beta = –11.6), regular gabapentin (beta = –39.1) and increased age (beta = –1) significantly correlated with decreased opioid consumption while clonidine use “remained associated” with increased opioid intake (beta = 11.6).
“In this cohort study, a care bundle including an individualized opioid regimen, regular gabapentin and clonidine as a rescue analgesic was associated with a significant decrease in the amount of opioids consumed after major colorectal surgery,” Gedda and colleagues concluded. “Gabapentin and an individualized opioid regimen were strongly and independently associated with this decrease and should be further evaluated as components of multimodal, opioid-free postoperative analgesia.”
Collapse
Read more about
Click Here to Manage Email Alerts