【原】围术期加巴喷丁不会减少老年患者术后谵妄：随机临床试验

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Perioperative Gabapentin Does Not Reduce Postoperative Delirium in Older Surgical Patients: A Randomized Clinical Trial

背景与目的

术后疼痛和阿片类药物的使用与术后谵妄有关。我们设计了一个单中心、随机、安慰剂对照、平行双盲试验，以确定围术期应用加巴喷丁是否减少非心脏手术的术后谵妄。

方  法

患者在术前和术后前3天随机接受安慰剂（N = 347）或加巴喷丁900 mg（N = 350）治疗。主要结局指标是通过意识模糊评估方法评估的术后谵妄。次要结局是术后疼痛、阿片类药物使用和住院时间。

结  果

697例患者纳入研究，平均年龄72±6岁。术后前3天谵妄总发生率为22.4％（加巴喷丁组为24.0％，安慰剂组为20.8％;差异为3.20％，95％CI，3.22％〜9.72％，P = 0.30）。据手术类型、麻醉类型或术前风险状态分级后，两组谵妄发生率无差异。加巴喷丁对阿片类药物有节约作用，加巴喷丁组阿片类用药剂量较对照组少。例如，加巴喷丁组的吗啡当量中位数6.7 mg（第25，第75百分位数为：1.3mg，20.0 mg），对照组中位数6.7 mg（第25，第75百分位数为：2.7mg，24.8 mg），差异存在于术后第一天（P = 0.04）。

结  论

虽然术后阿片类药物的使用减少，但围术期应用加巴喷丁并不会减少术后谵妄或住院时间。

原始文献摘要

Leung JM, Sands LP, Chen N, et al. Perioperative Gabapentin Does Not Reduce Postoperative Delirium in Older Surgical Patients: A Randomized Clinical Trial[J]. Anesthesiology，2017，[Epub ahead of print]  doi: 10.1097/ALN.0000000000001804.

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.

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