JU INSIGHT Gabapentin for Postoperative Pain Control and Opioid Reduction in Scrotal Surgery

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JU INSIGHT Gabapentin for Postoperative Pain Control and Opioid Reduction in Scrotal Surgery

By: Nahid Punjani, MD*, Weill Cornell Medicine, New York, New York Now with Mayo Clinic, Phoenix, Arizona; Jessica A. Marinaro, MD*, Weill Cornell Medicine, New York, New York; Caroline Kang, MD, Weill Cornell Medicine, New York, New York Now with Atrium Health, Charlotte, North Carolina; Jonathan Gal, MD, Weill Cornell Medicine, New York, New York; Brady Rippon, MPH, Weill Cornell Medical College, New York, New York; Rohan Jotwani, MD, Weill Cornell Medicine, New York, New York; Roniel Weinberg, MD, Weill Cornell Medicine, New York, New York Now with Lenox Hill Hospital, New York, New York; Peter N. Schlegel, MD, Weill Cornell Medicine, New York, New York; *Co-first authors. | Posted on: 20 May 2024

Punjani N, Marinaro JA, Kang C, et al. Gabapentin for postoperative pain control and opioid reduction in scrotal surgery: a randomized controlled clinical trial. J Urol. 2024;211(5):658-666. doi:10.1097/JU.0000000000003884

Study Need and Importance

Scrotal surgical procedures are perceived as being painful, a concern that limits effective acceptance of surgical interventions that may be critical for male infertility treatment. In addition, there are relatively few reproductive studies of high quality. The highest quality studies are randomized controlled trials, where patients are randomly assigned to a treatment or control group. This provides the strongest evidence for the role of a treatment such as medication to prevent pain after scrotal surgery.

What We Found

Men who received the medication gabapentin had less pain early after surgery as well as later in their recovery, as measured by pain scores (patient self-reports of the amount of pain after surgery). Opioid use was not significantly different, but on the day of surgery, men on placebo (sugar pill) took an average of 1.5 narcotic pills vs 1.1 pills for men taking gabapentin (Table).

Table. Summary of Results of Gabapentin Pain Prevention Trial

	Placebo	Gabapentin
Early pain scores (d 1), mean	3.1	1.9
Late pain scores (d 7), mean	2.2	1.2
Pain control satisfaction	81%	88%
Total opioid use (d 1), mean, pills	1.5	1.1

Limitations

The number of patients studied was low (35 in each group), and the magnitude of decrease in pain score was not absolute, meaning that gabapentin did not prevent all pain, and the number of narcotic pills was not different in gabapentin- vs control-treated patients. Also, the patients evaluated in this trial mostly underwent microdissection testicular sperm extraction surgery, so it is not clear how broadly effective this intervention is in preventing pain after all scrotal surgical procedures.

Interpretation for Patient Care

Pain prevention is widely recognized as a better management after surgery. This study shows that gabapentin taken before and after scrotal surgery was effective in preventing pain. Prior studies have also shown that celecoxib (combined with gabapentin in this study) is effective at preventing pain. Use of gabapentin and celecoxib is effective at preventing pain after surgery and should be part of perioperative management. No increase in side effects was seen with gabapentin.