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Impact of Gabapentin on PACU Length of Stay and Perioperative Intravenous Opioid Use for ERAS Hysterectomy Patients

  • Implementation Science & Operations Management
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Abstract

We investigated the impact of preoperative gabapentin on perioperative intravenous opioid requirements and post anesthesia care unit length of stay (PACU LOS) for patients undergoing laparoscopic and vaginal hysterectomies within an Enhanced Recovery After Surgery (ERAS) pathway. A multidisciplinary team retrospectively examined 2,015 patients who underwent laparoscopic or vaginal hysterectomies between October 2016 and January 2020 at a single academic institution. The average PACU LOS was 168 min among patients who did not receive gabapentin vs. 180 min both among patients who received ≤ 300 mg of gabapentin and patients who received > 300 mg of gabapentin. After adjusting for demographics and medical comorbidities, PACU LOS for patients given ≤ 300 mg gabapentin was 6% longer (rate ratio (RR) = 1.06, 95% CI = 1.01–1.11) than for patients who were not given gabapentin, and for patients who received > 300 mg of gabapentin was 7% longer (RR = 1.07, 95%CI = 1.01–1.13) than for those who did not receive gabapentin. Patients who received ≤ 300 mg gabapentin received 9% less perioperative intravenous hydromorphone than patients who did not receive gabapentin (RR = 0.91, 95% CI = 0.86 – 0.97); patients who received > 300 mg of gabapentin received 12% less perioperative intravenous hydromorphone than patients who did not receive gabapentin (RR = 0.88, 95% CI = 0.82 – 0.95). These findings represent an absolute difference of 0.09 mg intravenous hydromorphone. There were no statistically significant differences in total intravenous fentanyl received. Preoperative gabapentin given as part of an ERAS pathway is associated with statistically but not clinically significant increases in PACU LOS and decreases in total perioperative intravenous opioid use.

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The retrospective data collected and analyzed for this study are available for examination if requested.

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SAS code used for statistical analysis is available for examination if requested.

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Funding

Massachusetts General Physicians Organization.

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Authors and Affiliations

  1. Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA

    Dan B. Ellis, Kai Qiu & Sheri Berg

  2. Department of Gynecology Oncology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA

    Rachel Sisodia

  3. Department of Anesthesiology, Salem Hospital, 81 Highland Avenue, Salem, MA, 01970, USA

    Meryl Paul

  4. Massachusetts General Physicians Organization, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA

    Michael K. Hidrue & Marcela G. del Carmen

  5. Director, Pharmacy Services, Integrated Care, Mass General Brigham, 399 Revolution Drive, Suite 950, Somerville, MA, 02145, USA

    Jevon Oliver

Authors
  1. Dan B. Ellis
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  2. Rachel Sisodia
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  3. Meryl Paul
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  4. Kai Qiu
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  5. Michael K. Hidrue
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  6. Sheri Berg
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  7. Jevon Oliver
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  8. Marcela G. del Carmen
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Contributions

All authors contributed text to the manuscript. Dan Ellis, Rachel Sisodia, and Marcela del Carmen helped design and implement the ERAS pathway.

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Correspondence to Dan B. Ellis.

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IRB 2017P000443 at Massachusetts General Hospital.

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Waived by IRB.

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The authors declare no conflicts of interest.

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Ellis, D.B., Sisodia, R., Paul, M. et al. Impact of Gabapentin on PACU Length of Stay and Perioperative Intravenous Opioid Use for ERAS Hysterectomy Patients. J Med Syst 46, 26 (2022). https://doi.org/10.1007/s10916-022-01815-1

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  • DOI: https://doi.org/10.1007/s10916-022-01815-1

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