Gabapentin as an Adjunct to Standard Postoperative Pain Management Protocol in Lower Extremity Surgery

Postoperative pain is a problem that plagues physicians and has since the dawn of the surgical arts. Many interventions are available and used as the standard such as preoperative local anesthetic blocks, opiates, both oral and intravenous, and nonsteroidal antiinflammatory drugs. Although the temptation often exists to increase the postoperative opiate dose, opiate abuse is an increasing problem. This abuse has fueled the search for nonopiate pain adjuncts. Gabapentinoids have been shown to both decrease postoperative pain and, secondarily, decrease opiate dependence. This is a growing field in medical research, although it is relatively lacking in the specialty of lower extremity orthopedic surgery. A PubMed query was performed for related articles, which found only 8 related to lower extremity orthopedic surgery, and of these, none addressed the foot or ankle. Studies involving chronic pain, nonorthopedic surgery, orthopedic procedures proximal to and including the hip, studies involving only pregabalin, and studies regarding cancer pain were excluded. The results from our literature review are encouraging regarding the addition of gabapentin as a regular, perioperative adjunctive pain medication because all studied reported data evaluating preoperative administration have shown a statistically significant reduction in postoperative pain and opiate consumption.