Postoperative Pain Management in Patients with Lower-Extremity Amputations: A Single-Institution Retrospective Analysis of the Effectiveness of Non-opioid Analgesics in Reduction of Opioid Use

TL;DR

This study found that using gabapentin and pregabalin can reduce opioid use in patients recovering from lower limb amputations.

Contribution

The study identifies specific non-opioid analgesics associated with reduced opioid use in post-amputation rehabilitation.

Findings

Gabapentin use was linked to a significant decrease in opioid requirements during inpatient rehabilitation.

Pregabalin also showed a significant association with reduced opioid use in multivariable analysis.

Acetaminophen, methocarbamol, and duloxetine did not show significant reductions in opioid use.

Abstract

Background: Pain management following lower extremity amputation remains a clinical challenge, particularly during inpatient rehabilitation. Although opioids are frequently used, their adverse effects and potential for prolonged use highlight the importance of multimodal pain strategies. This study investigated the relationship between specific non-opioid analgesics and reductions in opioid use among patients undergoing inpatient rehabilitation after major lower extremity amputation.

Methods: A retrospective review was conducted at a single inpatient rehabilitation facility (IRF), examining opioid utilization measured in morphine milligram equivalents (MME) and the concurrent use of non-opioid agents, including acetaminophen, methocarbamol, gabapentin, pregabalin, and duloxetine. Eighty-one patients admitted between January 2021 and December 2023 were included. Admission and discharge opioid requirements were compared with daily non-opioid doses. Statistical analyses were performed using STATA version 3 (StataCorp LLC, College Station, TX).

Results: Gabapentin use was associated with a significant decrease in MME from admission to discharge (p=0.04), with an average daily dose of 1000 mg corresponding to a reduction of 1 MME per day. In multivariable analysis incorporating all non-opioid medications, gabapentin and pregabalin both showed significant associations with reduced MME (p=0.021 and p=0.027, respectively).

Conclusion: Among patients recovering from lower extremity amputation during inpatient rehabilitation, gabapentin use was significantly associated with lower opioid requirements, with pregabalin demonstrating a similar pattern. Incorporating these agents into multimodal analgesic regimens may help optimize postoperative pain control and limit opioid exposure. Further research is warranted to explore the role of additional non-opioid options in this setting.

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