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Post by BGardner on Dec 13, 2019 18:46:16 GMT -5
As most people here I have never had a patient c/o edema, or hemodynamic problems while taking Gabapentin but oftentimes in combination with the multimodal premedications we give with the ERAS protocol we do see some somnolence, not usually hypotension that is noteworthy. I think Gabapentin does have a place as part of a multimodal non narcotic pain management but think it worth while routinely evaluating for any potential heart failure before giving. Thanks Dahlia, this is very interesting!
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Kristen Praesel Lang
Guest
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Post by Kristen Praesel Lang on Dec 16, 2019 11:59:22 GMT -5
1. Have you ever had a patient mention they had peripheral edema or changes in BP while on gabapentin? No I have not had a patient report peripheral edema or changes in their blood pressure while taking gabapentin. 2. Do you see prolonged somnolence or hypotensive episodes in PACU after gabapentin given in preop not associated with other possible causes, i.e. hypovolemia, over narcotized, benzodiazepine use, or residual anesthesia on board? I have noticed that patients who were more sleepy after the ERAS protocol in the pacu who had received gabapentin. It's difficult to pinpoint if it could be attributed to gabapentin alone versus residual anesthesia. 3. What is your opinion regarding gabapentin use for outpatient procedures as part of an ERAS protocol? Overall, I support the use of gabapentin in the ERAS protocol (in pt's without cardiac risk factors, despite it's rare side effects) and think it could be beneficial for outpatient procedures as well.
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nanci
Junior Member
Posts: 57
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Post by nanci on Dec 16, 2019 16:16:28 GMT -5
1. Have you ever had a patient mention they had peripheral edema or changes in BP while on gabapentin? No I have not had this happen yet. 2. Do you see prolonged somnolence or hypotensive episodes in PACU after gabapentin given in preop not associated with other possible causes, i.e. hypovolemia, over narcotized, benzodiazepine use, or residual anesthesia on board? I have had somnolent patients with the ERAS protocols who receive Gabapentin as part of their multimodal ERAS regimen. 3. What is your opinion regarding gabapentin use for outpatient procedures as part of an ERAS protocol? I think that it works well for our ERAS cases so may be a good adjunct to use for pain management, would have to be mindful of the dosage(s) being given and hope that it does not add to time to discharge in the outpatient setting.
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Post by Amy Swank CRNA on Dec 18, 2019 15:16:46 GMT -5
1. I have not witnessed an untoward reaction (to my knowledge) that could be attributed to gabapentin. 2. I haven't seen excessive somnolence in PACU that would have just been related to gabapentin. 3. I find that gabapentin is a worthwhile adjunct, especially with the chronic pain patient population and ERAS. I can't help but wonder if this patient's personal smoking history and her familial cardiac history played more of a role in her cardiac issues?
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Post by Christine Velarde on Dec 26, 2019 13:40:08 GMT -5
1. I have not had a patient state that they had peripheral edema or changes in b/p while on gabapentin. 2. Although I have not done ERAS cases I have had patients taking gabapentin for pain management. I think this drug is given to prevent narcotic prescriptions. I thought in one case that gabapentin caused somnolence post procedure since no narcotic was given. 3.I think knowing potential risks of gabapentin is important so that post -procedure incidences can be explained. If gabapentin was included in any protocol I would administer the drug if possible to decrease post-op opioids.
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Post by Amy Schutter on Dec 26, 2019 14:04:36 GMT -5
1. I have never had a patient admit to any peripheral edema or BP changes while on gabapentin 2. I have definitely seen prolonged somnolence in PACU related to gabapentin use. The other institution I worked prior to Hopkins, certain orthopedic surgeons would frequently order gabapentin 300mg prior to outpatient procedures regardless of length of surgery. When compared to other ortho patients undergoing the same procedure (different surgeon) not receiving gabapentin patient LOS was >30 min longer due to somnolence. (Exact same anesthetic otherwise). 3. I think Gabapentin as an adjunct to our anesthetic is certainly beneficial, caution should be used on dosage especially in the outpatient setting. ERAS protocol and dosages of medications should be individualized based on patient history. Interesting article!
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Post by Chuck Eder on Dec 28, 2019 22:18:20 GMT -5
I have never had a patient mention any changes like edema or blood pressure issues. Of course, we are usually around for a brief portion of the patient's care and typically only a one time dose of the med. Unless the patient brings it up as a previous issue with the drug.
I haven't experienced any prolonged somnolence or hypotension that gets targeted toward gabapentin dosing. I do have a relative that has recently started taking gabapentin for peripheral neuropathy and is often fatigued without hypotension.
I typically only order gabapentin for outpatient procedures on those that are already taking the med regularly or have narcotic dependency issues.
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Post by Soo-Ok Kim on Dec 29, 2019 21:39:13 GMT -5
1.No, I have not heard of those complaints. It is challenging to follow up postoperatively since we encounter patient briefly in postop period.
2.No, I haven't experience that. It is also hard to eliminate all other factors related to those mentioned issues since patients may have received multimodal pain control regimen including Gabapentin.
3.I typically don't use Gabapentin on outpatient procedures and limit to those whom would have significant postop pain.
Thank you for this article to consider the rare side effects/complications since Gabapentin is used widely as an ERAS protocol.
Soo-Ok
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Post by Lu Lin on Dec 30, 2019 13:29:53 GMT -5
1. No, I have not had any patients mention to me of BP changes or peripheral edema on gabapentin.
2. No I have not seen prolonged sedation or HOTN in the recovery room for patients on gabapentin. But it is also difficult to attribute any of these side effects with gabapentin exclusively.
3. I believe its overall benefits for the general population are positive enough.
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Post by Vania Milnes on Dec 30, 2019 14:43:07 GMT -5
1. I have not seen or heard of peripheral edema or BP changes exclusively due to Gabapentin. That being said, we generally give such a variety of drugs it would usually be difficult to pinpoint Gaba as the culprit of these changes.
2.Again, I don't know that I've seen these issues in PACU strictly related to Gabapentin. I have never given Gaba in a situation without other confounding factores involved.
3. I believe Gabapentin is a great multi-modal plan for pain control peri and postoperatively. However, as other have mentioned, we have to be careful about simply ordering the "ERAS protocol" drugs, or any drugs for that matter just out of habit. I think this is a good reminder for me to always be vigilant and take every patient's individual needs and potential complications into account before any case.
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