Association of Gabapentinoids With the Risk of Opioid-Related Adverse Events in Surgical Patients in the United States.
JAMA Netw Open
; 3(12): e2031647, 2020 12 01.
Article
en En
| MEDLINE
| ID: mdl-33372975
ABSTRACT
Importance The use of gabapentinoids in multimodal postoperative analgesia is increasing; however, when coadministered with opioids, these drugs may potentiate central nervous system and respiratory depression. Objective:
To evaluate the association between perioperative coadministration of gabapentinoids and opioids with inpatient opioid-related adverse events in surgical patients. Design, Setting, andParticipants:
This cohort study used propensity score trimming, stratification, and weighting of adults admitted for a major surgery between October 2007 and December 2017 who were treated with opioids on the day of surgery and included in the Premier Research database. Data analysis was conducted from February to April 2020. Exposure Gabapentinoids (gabapentin or pregabalin) coadministered with opioids starting the day of surgery vs opioid therapy without gabapentinoids. Main Outcomes andMeasures:
Primary outcome was opioid overdose. Secondary outcomes included respiratory complications, unspecified adverse effects of opioid use, and a composite of these 3 outcomes. Patients were followed up for as long as 30 days from the day of surgery until deviation from the initial treatment regimen or discharge.Results:
Gabapentinoids with opioids were administered to 892â¯484 of 5â¯547â¯667 eligible admissions (16.1%; mean [SD] age, 63.5 [11.8] years; 353â¯315 [39.6%] men). Among the 4â¯655â¯183 patients who received opioids only, the mean (SD) age was 63.7 (14.7) years, and 1â¯913â¯284 (41.1%) were men. Overall, 441 overdose events were identified, with absolute risks of 1.4 per 10â¯000 patients with gabapentinoid exposure and 0.7 per 10â¯000 patients receiving opioids only. Following propensity score trimming, the cohort included 737â¯383 patients exposed to gabapentinoids and 3â¯002â¯480 patients receiving opioids only. The primary analysis yielded the adjusted hazard ratio of 1.95 (95% CI, 1.49-2.55), and the number needed to treat for an additional overdose to occur was 16â¯914 patients (95% CI, 11â¯556-31â¯537 patients). Adjusted hazard ratios for secondary outcomes were 1.68 (95% CI, 1.59-1.78) for respiratory complications, 1.77 (95% CI, 1.61-1.93) for unspecified adverse effects of opioids, and 1.70 (95% CI, 1.62-1.79) for the composite outcome. The results were consistent across sensitivity analyses and subgroups identified by key clinical factors. Conclusions and Relevance In this real-world cohort study of patients who underwent major surgery, concomitant use of gabapentinoids with opioids was associated with increased risk of opioid overdose and other opioid-related adverse events; however, the absolute risk of adverse events was low.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Dolor Postoperatorio
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Sobredosis de Droga
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Gabapentina
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Analgésicos Opioides
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Trastornos Relacionados con Opioides
Tipo de estudio:
Etiology_studies
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Evaluation_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Aged
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Female
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Humans
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Male
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Middle aged
País/Región como asunto:
America do norte
Idioma:
En
Revista:
JAMA Netw Open
Año:
2020
Tipo del documento:
Article