Appropriateness of gabapentinoid prescription for surgical and trauma pain in gabapentinoid‐naïve patients: a retrospective review

Background The gabapentinoids pregabalin and gabapentin are not recommended for managing acute pain in the absence of neuropathic symptoms, but such use is prominent in this setting. Aim To assess gabapentinoid prescribing practices for gabapentinoid-naive patients after surgery and trauma. Methods A retrospective review of surgical and trauma admissions at a large, Australian, tertiary teaching hospital for patients prescribed a gabapentinoid for the first time, from February 2019 to May 2019, inclusive. Results One hundred and eighty-nine of 5494 (3.4%) gabapentinoid-naive surgical and trauma inpatients were prescribed a gabapentinoid, with 110 of the 189 (58.2%) also discharged on a gabapentinoid. Of the 110 patients, 60 (54.5%) were prescribed a gabapentinoid for either non-neuropathic pain or undocumented pain indication, and the remainder for neuropathic symptoms. Only 66 (60.0%) patients discharged with a gabapentinoid had a plan for further management such as de-escalation or general practitioner follow-up. Of the 67 prescriptions written for patients on discharge, 32 (47.8%) were written as non-government subsidised prescriptions. Four patients considered at high risk of developing addictive behaviours were discharged on a gabapentinoid. Conclusion In this study, initiation and maintenance of gabapentinoid therapy in previously naive surgical and trauma patients was infrequent, although it was often prescribed for an unclear or non-neuropathic indication with little provision of, or no information for, intended duration of use. This review provides an opportunity for further intervention at the transition of care to minimise inappropriate long-term gabapentinoid use and could be used to facilitate further research evaluating the impact of hospital-prescribed gabapentinoids in the community.