■加巴喷丁已被用于加强手术后恢复(ERAS)途径,以控制接受动态泌尿外科手术的患者的疼痛;然而,它可能会导致不良的副作用。我们研究了微创手术后加巴喷丁与康复速度和围手术期疼痛管理之间的因果关系。
■我们在2018年至2022年之间确定了2397例≤65岁的患者接受前列腺切除术或肾切除术;131例(5.5%)未接受加巴喷丁。我们测试了加巴喷丁使用对出院时间和围手术期阿片类药物消耗的影响,分别,使用多变量线性回归调整潜在的混杂因素,包括年龄,性别,BMI,美国麻醉医师协会评分,和手术类型。
■关于调整后的分析,我们发现,在接受加巴喷丁治疗和未接受加巴喷丁治疗的患者中,没有发现出院时间有差异的证据(加巴喷丁治疗的校正后差异缩短0.07小时;95%CI-0.17,0.31;P=.6).没有证据表明加巴喷丁服用术中阿片类药物的消耗有差异(调整后差异-1.5吗啡毫克当量;95%CI-4.2,1.1;P=3)或在24小时内处于术后阿片类药物消耗的前四分位数的可能性(调整后差异4.2%;95%CI-4.8%,13%;P=4)。我们认为加巴喷丁收到的混杂因素没有重要差异,这表明因果结论是合理的。
■我们的置信区间不包括加巴喷丁的临床意义益处,当与ERAS协议一起使用时,在住院时间或围手术期阿片类药物使用方面。这些结果支持从ERAS方案中省略加巴喷丁用于微创泌尿肿瘤手术。
UNASSIGNED: Gabapentin has been used in enhanced recovery after surgery (ERAS) pathways for pain control for patients undergoing ambulatory uro-oncologic surgery; however, it may cause undesirable side effects. We studied the causal association between
gabapentin and rapidity of recovery and perioperative pain management after minimally invasive uro-oncologic surgery.
UNASSIGNED: We identified 2397 patients ≤ 65 years undergoing prostatectomies or nephrectomies between 2018 and 2022; 131 (5.5%) did not receive gabapentin. We tested the effect of gabapentin use on time of discharge and perioperative opioid consumption, respectively, using multivariable linear regression adjusting for potential confounders including age, gender, BMI, American Society of Anesthesiologists score, and surgery type.
UNASSIGNED: On adjusted analysis, we found no evidence of a difference in discharge time among those who did vs did not receive gabapentin (adjusted difference 0.07 hours shorter on
gabapentin; 95% CI -0.17, 0.31; P = .6). There was no evidence of a difference in intraoperative opioid consumption by
gabapentin receipt (adjusted difference -1.5 morphine milligram equivalents; 95% CI -4.2, 1.1; P = .3) or probability of being in the top quartile of postoperative opioid consumption within 24 hours (adjusted difference 4.2%; 95% CI -4.8%, 13%; P = .4). We saw no important differences in confounders by
gabapentin receipt suggesting causal conclusions are justified.
UNASSIGNED: Our confidence intervals did not include clinically meaningful benefits from gabapentin, when used with an ERAS protocol, in terms of length of stay or perioperative opioid use. These results support the omission of gabapentin from ERAS protocols for minimally invasive uro-oncologic surgeries.