Newly Published
Perioperative Medicine  |   July 2017
Perioperative Gabapentin Does Not Reduce Postoperative Delirium in Older Surgical Patients: A Randomized Clinical Trial
Author Notes
  • From the Departments of Anesthesia and Perioperative Care (J.M.L., S.K.), Neurosurgery (C.A., D.C., P.W.), Orthopedic Surgery (S. Bergven, S. Burch, V.D., M.R., B.T., T.V.), and Medicine (K.C.) and Memory and Aging Center (J.H.K.), University of California San Francisco, San Francisco, California; Virginia Tech, Blacksburg, Virginia (L.P.S.); Department of Statistics, Purdue University, West Lafayette, Indiana (N.C.); Department of Surgery & Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, Texas (K.B.).
  • participated in patient recruitment, cognitive assessments, data entry, and data management
  • participated in patient recruitment, cognitive assessments, data entry, and data management
  • participated in patient recruitment, cognitive assessments, data entry, and data management
  • participated in patient recruitment, cognitive assessments, data entry, and data management
  • participated in patient recruitment, cognitive assessments, data entry, and data management
  • participated in patient recruitment, cognitive assessments, data entry, and data management
  • *Members of the Perioperative Medicine Research Group are listed in appendix 1.
    Members of the Perioperative Medicine Research Group are listed in appendix 1.×
  • Submitted for publication July 15, 2016. Accepted for publication June 27, 2017.
    Submitted for publication July 15, 2016. Accepted for publication June 27, 2017.×
  • Research Support: Supported in part by National Institutes of Health grants AG031795-05 and 5R21AG048456-02 (Bethesda, Maryland; to Dr. Leung).
    Research Support: Supported in part by National Institutes of Health grants AG031795-05 and 5R21AG048456-02 (Bethesda, Maryland; to Dr. Leung).×
  • Competing Interests: The authors declare no competing interests.
    Competing Interests: The authors declare no competing interests.×
  • Reproducible Science: Full protocol available at: Jacqueline.Leung@ucsf.edu. Raw data available at: Jacqueline.Leung@ucsf.edu.
    Reproducible Science: Full protocol available at: Jacqueline.Leung@ucsf.edu. Raw data available at: Jacqueline.Leung@ucsf.edu.×
  • Correspondence: Address correspondence to Dr. Leung: Department of Anesthesia and Perioperative Care, University of California San Francisco, 500 Parnassus Avenue, Room MUE-415, San Francisco, California 94143–0648. Jacqueline.Leung@ucsf.edu.Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Central and Peripheral Nervous Systems
Perioperative Medicine   |   July 2017
Perioperative Gabapentin Does Not Reduce Postoperative Delirium in Older Surgical Patients: A Randomized Clinical Trial
Anesthesiology Newly Published on July 20, 2017. doi:10.1097/ALN.0000000000001804
Anesthesiology Newly Published on July 20, 2017. doi:10.1097/ALN.0000000000001804
Abstract

Background: Postoperative pain and opioid 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.

Methods: Patients were randomly assigned to receive placebo (N = 347) or gabapentin 900 mg (N = 350) administered preoperatively and for the first 3 postoperative days. The primary outcome was postoperative delirium as measured by the Confusion Assessment Method. Secondary outcomes were postoperative pain, opioid use, and length of hospital stay.

Results: Data for 697 patients were included, with a mean ± SD age of 72 ± 6 yr. The overall incidence of postoperative delirium in any of the first 3 days was 22.4% (24.0% in the gabapentin and 20.8% in the placebo groups; the difference was 3.20%; 95% 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 versus the control group. For example, the morphine equivalents for the gabapentin-treated group, median 6.7 mg (25th, 75th quartiles: 1.3, 20.0 mg), versus control group, median 6.7 mg (25th, 75th quartiles: 2.7, 24.8 mg), differed on the first postoperative day (P = 0.04).

Conclusions: Although postoperative opioid use was reduced, perioperative administration of gabapentin did not result in a reduction of postoperative delirium or hospital length of stay.