Attention: Restrictions on use of AUA, AUAER, and UCF content in third party applications, including artificial intelligence technologies, such as large language models and generative AI.
You are prohibited from using or uploading content you accessed through this website into external applications, bots, software, or websites, including those using artificial intelligence technologies and infrastructure, including deep learning, machine learning and large language models and generative AI.
UPJ INSIGHT Gabapentin and Rapidity of Recovery in Minimally Invasive Ambulatory Uro-Oncologic Surgeries
By: Eleni Kohilakis, BS, Albert Einstein College of Medicine, Bronx, New York; Melissa Assel, MS, Memorial Sloan Kettering Cancer Center, New York, New York; Joanna Serafin, PhD, Memorial Sloan Kettering Cancer Center, New York, New York; Meghana Mehta, MS, Memorial Sloan Kettering Cancer Center, New York, New York; Taylor McCready, MPH, Memorial Sloan Kettering Cancer Center, New York, New York, University Grossman School of Medicine, New York, New York; Hanae K. Tokita, MD, Memorial Sloan Kettering Cancer Center, New York, New York, Weill Cornell Medicine, New York, New York; Patrick J. McCormick, MD, MEng, Memorial Sloan Kettering Cancer Center, New York, New York, Weill Cornell Medicine, New York, New York; Andrew J. Vickers, PhD, Memorial Sloan Kettering Cancer Center, New York, New York; Sigrid V. Carlsson, MD, PhD, MPH, Memorial Sloan Kettering Cancer Center, New York, New York, Sahlgrenska Academy at Gothenburg University, Sweden; Vincent P. Laudone, MD, Memorial Sloan Kettering Cancer Center, New York, New York; Anoushka M. Afonso, MD, Memorial Sloan Kettering Cancer Center, New York, New York, Weill Cornell Medicine, New York, New York | Posted on: 17 Jul 2024
Kohilakis E, Assel M, Serafin J, et al. Gabapentin and rapidity of recovery among patients undergoing ambulatory uro-oncologic surgeries. Urol Pract. 2024;11(4):746-751. doi:10.1097/UPJ.0000000000000570
Study Need and Importance
Optimal pain management is crucial for patients undergoing minimally invasive uro-oncologic surgeries, such as prostatectomies or nephrectomies. Gabapentin has been integrated into enhanced recovery after surgery (ERAS) protocols for pain control to reduce opioid consumption and expedite postoperative recovery; however, this medication may have undesirable side effects. In this study, we examined gabapentin’s impact on rapidity of recovery and perioperative pain management, addressing the need for evidence-based modifications to current ERAS protocols.
What We Found
In this retrospective cohort study, we identified 2397 patients undergoing minimally invasive prostatectomies or nephrectomies at an ambulatory surgery center, of whom 2266 received gabapentin and 131 did not. We found no evidence of a difference in postoperative length of stay or perioperative opioid consumption between patients who received gabapentin and those who did not. Our confidence intervals did not include clinically meaningful benefit of gabapentin (Table), when used within an established ERAS protocol, supporting the omission of gabapentin from ERAS protocols for uro-oncologic surgeries.
Table. Outcomes by Gabapentin Receipt Summarized as Mean (SD) for Discharge Time and Intraoperative Morphine Milligram Equivalents and as Count (%) for Postoperative Morphine Milligram Equivalents ≥ 5.67 Within 24 Hours, Transfers, and Reoperations
| Characteristic | No gabapentin | Gabapentin | Difference | 95% CI | P value |
|---|---|---|---|---|---|
| Intraoperative MMEs, mean (SD) | 40 (17) | 44 (15) | −1.5 adjusted difference | −4.2, 1.1 | .3 |
| Postoperative MMEs within 24 h ≥5.67, No. (%) | 48 (37) | 578 (26) | 4.2 adjusted difference | −4.8, 13 | .4 |
| Discharge time, mean (SD), h | 11.4 (1.3) | 11.3 (1.4) | 0.07 adjusted difference | −0.17, 0.31 | .6 |
| Transfer, No. (%) | 2 (1.5) | 20 (0.9) | 0.64 risk difference | −1.9, 3.2 | .8 |
| Reoperation prior to discharge, No. (%) | 0 (0) | 1 (<0.1) | 0.04 risk difference | −0.09, 0.17 | > .9 |
| Abbreviations: MMEs, morphine milligram equivalents. | |||||
| The adjusted differences, 95% CI and P values are calculated using multivariable linear regression for discharge time and intraoperative MMEs and multivariable logistic regression for postoperative MMEs ≥ 5.67 within 24 hours. For the outcomes of transfers and reoperations prior to discharge, unadjusted risk differences and 95% CI are presented; P values were calculated using Fisher’s exact test. Differences and 95% CI are presented as the decrease associated with gabapentin receipt. |
Limitations
The retrospective nature of the analysis and the specific patient demographics (≤65 years) may limit the generalizability of the results across broader populations and settings.
Interpretation for Patient Care
Given the lack of demonstrated benefit of gabapentin in terms of postoperative length of stay or perioperative opioid use, and the importance of minimizing unnecessary medication use, this study supports the omission of gabapentin within ERAS protocols for minimally invasive uro-oncologic surgeries.
advertisement
advertisement