Integrating Adjuvant Analgesics into Perioperative Pain Practice: Results from an Academic Medical Center

Kuo Kai Chin, Ian Carroll, Karishma Desai, Steven Asch, Tina Seto, Kathryn M. McDonald, Catherine Curtin, Tina Hernandez-Boussard

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Opioid-sparing postoperative pain management therapies are important considering the opioid epidemic. Total knee arthroplasty (TKA) is a common and painful procedure accounting for a large number of opioid prescriptions. Adjuvant analgesics, nonopioid drugs with primary indications other than pain, have shown beneficial pain management and opioid-sparing effects following TKA in clinical trials. We evaluated the adjuvant analgesic gabapentin for its usage patterns and its effects on opioid use, pain, and readmissions. METHODS: This retrospective, observational study included 4,046 patients who received primary TKA between 2009 and 2017 using electronic health records from an academic tertiary care medical institute. Descriptive statistics and multivariate modeling were used to estimate associations between inpatient gabapentin use and adverse pain outcomes as well as inpatient oral morphine equivalents per day (OME). RESULTS: Overall, there was an 8.72% annual increase in gabapentin use (P < 0.001). Modeled estimates suggest that gabapentin is associated with a significant decrease in opioid consumption (estimate = 0.63, 95% confidence interval = 0.49-0.82, P < 0.001) when controlling for patient characteristics. Patients receiving gabapentin had similar discharge pain scores, follow-up pain scores, and 30-day unplanned readmission rates compared with patients receiving no adjuvant analgesics (P > 0.05). CONCLUSIONS: When assessed in a real-world setting over a large cohort of TKA patients, gabapentin is an effective pain management therapy that is associated with reduced opioid consumption-a national priority in this time of opioid crisis-while maintaining the same quality of pain management.

Original languageEnglish (US)
Pages (from-to)161-170
Number of pages10
JournalPain medicine (Malden, Mass.)
Volume21
Issue number1
DOIs
StatePublished - Jan 1 2020
Externally publishedYes

Fingerprint

Opioid Analgesics
Analgesics
Knee Replacement Arthroplasties
Pain
Pain Management
Inpatients
Electronic Health Records
Tertiary Healthcare
Postoperative Pain
Morphine
Observational Studies
Prescriptions
Retrospective Studies
Clinical Trials
gabapentin
Therapeutics

Keywords

  • adjuvant analgesic
  • Gabapentin
  • knee arthroplasty
  • opioid-sparing

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Integrating Adjuvant Analgesics into Perioperative Pain Practice : Results from an Academic Medical Center. / Chin, Kuo Kai; Carroll, Ian; Desai, Karishma; Asch, Steven; Seto, Tina; McDonald, Kathryn M.; Curtin, Catherine; Hernandez-Boussard, Tina.

In: Pain medicine (Malden, Mass.), Vol. 21, No. 1, 01.01.2020, p. 161-170.

Research output: Contribution to journalArticle

Chin, KK, Carroll, I, Desai, K, Asch, S, Seto, T, McDonald, KM, Curtin, C & Hernandez-Boussard, T 2020, 'Integrating Adjuvant Analgesics into Perioperative Pain Practice: Results from an Academic Medical Center', Pain medicine (Malden, Mass.), vol. 21, no. 1, pp. 161-170. https://doi.org/10.1093/pm/pnz053
Chin, Kuo Kai ; Carroll, Ian ; Desai, Karishma ; Asch, Steven ; Seto, Tina ; McDonald, Kathryn M. ; Curtin, Catherine ; Hernandez-Boussard, Tina. / Integrating Adjuvant Analgesics into Perioperative Pain Practice : Results from an Academic Medical Center. In: Pain medicine (Malden, Mass.). 2020 ; Vol. 21, No. 1. pp. 161-170.
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AB - BACKGROUND: Opioid-sparing postoperative pain management therapies are important considering the opioid epidemic. Total knee arthroplasty (TKA) is a common and painful procedure accounting for a large number of opioid prescriptions. Adjuvant analgesics, nonopioid drugs with primary indications other than pain, have shown beneficial pain management and opioid-sparing effects following TKA in clinical trials. We evaluated the adjuvant analgesic gabapentin for its usage patterns and its effects on opioid use, pain, and readmissions. METHODS: This retrospective, observational study included 4,046 patients who received primary TKA between 2009 and 2017 using electronic health records from an academic tertiary care medical institute. Descriptive statistics and multivariate modeling were used to estimate associations between inpatient gabapentin use and adverse pain outcomes as well as inpatient oral morphine equivalents per day (OME). RESULTS: Overall, there was an 8.72% annual increase in gabapentin use (P < 0.001). Modeled estimates suggest that gabapentin is associated with a significant decrease in opioid consumption (estimate = 0.63, 95% confidence interval = 0.49-0.82, P < 0.001) when controlling for patient characteristics. Patients receiving gabapentin had similar discharge pain scores, follow-up pain scores, and 30-day unplanned readmission rates compared with patients receiving no adjuvant analgesics (P > 0.05). CONCLUSIONS: When assessed in a real-world setting over a large cohort of TKA patients, gabapentin is an effective pain management therapy that is associated with reduced opioid consumption-a national priority in this time of opioid crisis-while maintaining the same quality of pain management.

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