Effect of Gabapentin on Sedation and Same Day Discharge in Gynecologic Laparoscopy

Abstract

Study Objective To compare sedation scores, pain scores, and hospital length of stay among patients undergoing outpatient minimally invasive gynecologic procedures based on preoperative gabapentin administration. Design Retrospective cohort study. Setting Academic teaching hospital. Patients or Participants The first thirty patients meeting inclusion and exclusion criteria for each group were selected in a retrospective manner. The sample size was calculated to detect a 1-point difference in the Aldrete sedation score. Patients undergoing outpatient gynecologic laparoscopic surgery with a single surgeon between May 2020 and March 2021 were eligible for inclusion. Interventions Dosages of routine preoperative gabapentin were sequentially decreased from 600 mg to 300 mg to none. Outcomes included sedation based on the Aldrete score and Pasero Opioid-Induced Sedation Scale (POSS) and pain based on the numerical rating scale during the initial recovery period. Rates of same day discharge and hospital length of stay were also tracked. Measurements and Main Results A total of 91 unique persons were included in the analysis. There was no difference between groups for age, race, ASA score, operating time, administered morphine equivalents, or benzodiazepine administration. Comparison between the three groups did not detect significant differences in either sedation scores or pain scores. Same day discharge did differ between groups with 89% of patients receiving 0 mg discharged on the day of surgery compared to 81% and 59% of patients in the 300 mg and 600 mg groups, respectively (p-value=0.019). Hospital length of stay did not reach a statistical difference. Conclusion No differences were identified in sedation or pain scores based on preoperative administration of gabapentin. The percentage of same day discharges was inversely related to dose of preoperative gabapentin, with 0 mg having the highest rate of same day discharge. These results support current recommendations to discontinue routine administration of gabapentin in outpatient gynecologic surgery. To compare sedation scores, pain scores, and hospital length of stay among patients undergoing outpatient minimally invasive gynecologic procedures based on preoperative gabapentin administration. Retrospective cohort study. Academic teaching hospital. The first thirty patients meeting inclusion and exclusion criteria for each group were selected in a retrospective manner. The sample size was calculated to detect a 1-point difference in the Aldrete sedation score. Patients undergoing outpatient gynecologic laparoscopic surgery with a single surgeon between May 2020 and March 2021 were eligible for inclusion. Dosages of routine preoperative gabapentin were sequentially decreased from 600 mg to 300 mg to none. Outcomes included sedation based on the Aldrete score and Pasero Opioid-Induced Sedation Scale (POSS) and pain based on the numerical rating scale during the initial recovery period. Rates of same day discharge and hospital length of stay were also tracked. A total of 91 unique persons were included in the analysis. There was no difference between groups for age, race, ASA score, operating time, administered morphine equivalents, or benzodiazepine administration. Comparison between the three groups did not detect significant differences in either sedation scores or pain scores. Same day discharge did differ between groups with 89% of patients receiving 0 mg discharged on the day of surgery compared to 81% and 59% of patients in the 300 mg and 600 mg groups, respectively (p-value=0.019). Hospital length of stay did not reach a statistical difference. No differences were identified in sedation or pain scores based on preoperative administration of gabapentin. The percentage of same day discharges was inversely related to dose of preoperative gabapentin, with 0 mg having the highest rate of same day discharge. These results support current recommendations to discontinue routine administration of gabapentin in outpatient gynecologic surgery.