Gabapentinoids – post op use

Possible benefits Risks Comment

 Clinically insignificant    Risk of  Once commonly
in pain dizziness recommended in past for
 Clinically insignificant  in and visual enhanced recovery after
opioid requirements disturbances surgery (ERAS) guidelines
  Risk of PONV   Risk of  Now recognised that benefits
opioid-induced have been over-estimated and
 No  postoperative ventilatory potential harms
chronic pain impairment underestimated
(OIVI)
 Routine perioperative use
not recommended
Ketamine
Possible benefits Risks Comment
  Postop pain intensity  Considered to be  Effective when used
  Postop safe and effective, for nociceptive and
opioid especially in the neuropathic pain
requirements low doses
 Clinically small  commonly used in  Can attenuate opioid
in PONV the perioperative tolerance
setting
 CNS adverse events
little different from
control
PS41 appendix – analgesic
stewardship
  Patient and carer education
Preadmission • Assess potential risk factors (psychological, opioid
misuse)

 Opioid medications  Assessment of analgesic

• long-acting opioids efficacy and adverse effects
Durin • opioid-sparing &  Daily review of opioid dose
opioid-free analgesia trajectories
g  Guidelines and order sets
 Non-opioid and adjuvant
analgesic medications  Preparation for discharge

 Analgesic prescriptions
At  Patient/carer education
 Communication with the patient’s treating