Perioperative Gabapentin Does Not Reduce Postoperative Delirium in Older Surgical Patients: A Randomized Clinical Trial.
Perioperative Gabapentin Does Not Reduce Postoperative Delirium in Older Surgical Patients: A Randomized Clinical Trial.
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DOI：
10.1097/aln.0000000000001804
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发表时间：
2017-10
期刊：
影响因子：
8.8
通讯作者：
Perioperative Medicine Research Group
中科院分区：
文献类型：
--
作者：
Leung JM;Sands LP;Chen N;Ames C;Berven S;Bozic K;Burch S;Chou D;Covinsky K;Deviren V;Kinjo S;Kramer JH;Ries M;Tay B;Vail T;Weinstein P;Chang S;Meckler G;Newman S;Tsai T;Voss V;Youngblom E;Perioperative Medicine Research Group
术后疼痛和阿片类药物的使用与术后谵妄有关。我们设计了一项单中心、随机、安慰剂对照、平行臂、双盲试验，以确定围手术期加巴喷丁给药是否能减少非心脏手术后的术后谵妄。患者被随机分配接受安慰剂（n = 347）或加巴喷丁900 mg（n=350）术前和术后前三天的管理。主要结局是通过意识模糊评估方法测量的术后谵妄。次要结局为术后疼痛、阿片类药物使用和住院时间。纳入了697例患者的数据，平均年龄为72 ± 6岁。术后前三天任何一天的谵妄总发生率为22.4%（加巴喷丁组为24.0%，安慰剂组为20.8%，差异为3.2%，{95%置信区间（CI）-3.22至9.72%}，P=0.30）。当按手术类型、麻醉类型或术前风险状态分层时，两组间谵妄的发生率无差异。加巴喷丁被证明是阿片类药物节省-与对照组相比，干预组的剂量较低。例如，加巴喷丁治疗组的吗啡当量中位数为6.7 mg（第25、75四分位数1.3、20.0 mg），对照组的吗啡当量中位数为6.7 mg（2.7、24.8），术后第一天差异较大，p =0.04。虽然术后阿片类药物的使用减少，加巴喷丁的围手术期管理并没有导致减少术后谵妄，或住院时间。
Postoperative pain and opioids use are associated with postoperative delirium. We designed a single center, randomized, placebo-controlled parallel-arm, double-blinded trial to determine whether perioperative administration of gabapentin reduced postoperative delirium after noncardiac surgery. Patients were randomly assigned to receive placebo (n = 347) or gabapentin 900 mg (n=350) administered preoperatively and for the first three postoperative days. The primary outcome was postoperative delirium as measured by the Confusion Assessment Methods. Secondary outcomes were postoperative pain, opioids use, and length of hospital stay. Data for 697 patients were included with a mean age of 72 ± 6 years. The overall incidence of postoperative delirium in any of the first three days was 22.4%, (24.0% in the gabapentin and 20.8% in the placebo groups, the difference was 3.2%, {95% confidence interval (CI) −3.22 to 9.72%}, P=0.30. The incidence of delirium did not differ between the two groups when stratified by surgery type, anesthesia type or preoperative risk status. Gabapentin was shown to be opioid sparing – with lower doses for the intervention group vs. control group. For example, the morphine equivalents for gabapentin treated group, median 6.7 mg (25th, 75th quartiles 1.3, 20.0 mg) vs. control groups, median 6.7 mg (2.7, 24.8) differed on the first postoperative day, p =0.04. Although postoperative opioids usage was reduced, perioperative administration of gabapentin did not result in a reduction of postoperative delirium, or hospital length of stay.