Effects of Preoperatively Administered Oral Gabapentin and Acetaminophen on Opioid Consumption When Added to an Analgesic Regimen Containing Dexamethasone for Abdominal and Vaginal Hysterectomies

Objective: The importance of reducing dependence on opioids for postoperative pain control is well-recognized, but there remains a paucity of data on the effectiveness of nonopioid analgesic multimodal regimens. The current authors evaluated the addition of preoperative oral gabapentin (GABA; 600 mg) and acetaminophen (ACET; 1000 mg) to intravenous (IV) dexamethasone (DEX; 8 mg) on perioperative opioid consumption in women undergoing abdominal and vaginal hysterectomies. Materials and Methods: This institutional review board-approved study analyzed data retrospectively from a quality-improvement initiative at Prentice Women's Hospital in Chicago, IL. Eligible women undergoing abdominal and vaginal hysterectomies received preoperative oral GABA (600 mg) and ACET (1000 mg) plus IV DEX (8 mg). Subjects in a control time period received DEX (8 mg) only. The primary outcome was morphine equivalents (morEqs) administered intraoperatively and in the postanesthesia care unit (PACU). Secondary outcomes included administration of antiemetics, vasopressors, analgesics, and total fluids. Results: There were 63 controls and 59 study subjects. Intraoperative opioid (mg as morEqs), had a median difference of 0.5 mg (95% confidence interval [CI]: -2.8 mg to 4.3 mg; p = 0.65), and PACU opioid use with a median difference of 0.7 mg (95% CI: -4.1 mg to 1.2 mg, p = 0.11) were not different. Fluid administration was not different, but vasopressor administration was greater in the study group, with a difference of 26% (95% CI: 8%-44%; p = 0.005). Conclusions: Preoperative oral GABA and ACET prior to abdominal and vaginal hysterectomies, in addition to IV DEX, were ineffective for decreasing opioid consumption. There was a 26% increase in intraoperative vasopressor use in the group receiving the preoperative GABA and ACET. This study demonstrates the importance of investigating nonopioid multimodal analgesic regimens to determine efficacy while minimizing polypharmacy.