PREOPERATIVE GABAPENTIN IN LAPAROSCOPIC SLEEVE GASTRECTOMY DOES NOT DECREASE INTRAOPERATIVE OR POSTOPERATIVE OPIATE USE OR LENGTH OF STAY
Chloe Williams, Richard Perugini
Surgery, UMASS, Worcester, Massachusetts, United States
INTRODUCTION: One target of Enhanced Recovery After Surgery (ERAS) programs is the use of multimodal pain therapy to minimize narcotics and to decrease complications and length-of-stay. The utility of ERAS initiatives in minimally invasive bariatric surgery programs is debatable, as length of stay is usually one day. We studied whether the addition of gabapentin to our ERAS protocol for laparoscopic vertical sleeve gastrectomy (LVSG) patients would lead to decreased opiate use and increased proportion of patients discharged on postoperative day one.
METHODS AND PROCEDURES: A retrospective, quantitative study was performed at a large metropolitan university tertiary hospital. The ERAS pathway for LVSG patients was modified in September 2018 to include gabapentin 600 mg preoperatively and 300 mg bid postoperatively. We measured compliance with this program over the next six months. We compared patients who did or did not receive gabapentin as part of a defined ERAS pathway. Primary outcomes were intraoperative fentanyl use, total intraoperative opiate use in morphine equivalents, postoperative in-hospital opiate use in morphine equivalents, and length of stay. Patients undergoing a concomitant operation (eg. hiatal hernia repair, gastric band removal, or cholecystectomy) were excluded from this analysis. Data was analyzed by unpaired two sample t-test.
RESULTS: In the six months studied, usage of preoperative gabapentin increased from 4% to 86%, and usage of postoperative gabapentin increased from 56% to 96%. There was no difference in patients receiving preoperative gabapentin (n=91) or those not receiving gabapentin (n=64) with respect to sex, age, BMI, or operative time. Patients who received gabapentin required a significant amount less of intraoperative fentanyl (Δ27.9 mcg, p=0.049). However, there was no difference in total intraoperative or postoperative opiate use as measured in morphine equivalents. Average length of stay for all patients was 1.25 days, with no difference between the two groups.
CONCLUSIONS: Preoperative gabapentin administration for LVSG patients appears to decrease some objective acute opioid requirements as demonstrated by significant reduction in intraoperative fentanyl administration. However, inclusion of preoperative gabapentin in our ERAS pathway did not otherwise reduce opiate consumption or length-of-stay in our cohort. Although low-risk and low-cost, preoperative gabapentin does not appear to be a meaningful addition to ERAS pathways for LVSG patients.
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