Eliza E Moskowitz1, Lucin Garabedian2, Kimberly Hardin3, Emily Perkins-Pride4, Menilik Asfaw5, Candice Preslaski6, Kiara N Leasia7, Ryan Lawless8, Clay Cothren Burlew9, Fredric Pieracci10. 1. Denver Health Medical Center University of Colorado School of Medicine, United States. Electronic address: eliza.moskowitz@ucdenver.edu. 2. Denver Health Medical Center University of Colorado School of Medicine, United States. Electronic address: lucin.garabedian@dhha.org. 3. Denver Health Medical Center University of Colorado School of Medicine, United States. Electronic address: kimberly.harden@dhha.org. 4. Denver Health Medical Center University of Colorado School of Medicine, United States. Electronic address: emily.perkinspride@dhha.org. 5. Denver Health Medical Center University of Colorado School of Medicine, United States. Electronic address: menilik.asfaw@dhha.org. 6. Denver Health Medical Center University of Colorado School of Medicine, United States. Electronic address: Candice.preslaski@dhha.org. 7. Denver Health Medical Center University of Colorado School of Medicine, United States. Electronic address: kiara.liasia@dhha.org. 8. Denver Health Medical Center University of Colorado School of Medicine, United States. Electronic address: ryan.lawless@dhha.org. 9. Denver Health Medical Center University of Colorado School of Medicine, United States. Electronic address: clay.cothren@dhha.org. 10. Denver Health Medical Center University of Colorado School of Medicine, United States. Electronic address: fredric.pieracci@dhha.org.
Abstract
INTRODUCTION: Achieving adequate pain control for rib fractures remains challenging; prescription of alternatives to narcotics is imperative to curtail the current opioid epidemic. Although gabapentin has shown promise following elective thoracic procedures, its efficacy in patients with rib fractures remains unstudied. We hypothesized that gabapentin, as compared to placebo, would both improve acute pain control and decrease narcotic use among critically ill patients with rib fractures. MATERIALS AND METHODS:Adult patients admitted to the trauma surgery service from November 2016 - November 2017 at an urban, LevelI trauma center with one or more rib fractures were randomized to either gabapentin 300 mg thrice daily or placebo for one month following their injury. Daily numeric pain scores, opioid consumption, oxygen requirement, respiratory rate, and incentive spirometry recordings during the index admission, as well as and one-month quality of life survey data were abstracted. RESULTS:Forty patients were randomized. The groups were well matched with respect to age, gender, prior narcotic use, tobacco use, and prior respiratory disease. Although the median RibScore did not differ between groups, the gabapentin group had a higher median number of ribs fractured as compared to the placebo group (7 vs. 5, respectively). Degree of pulmonary contusion and injury severity score were similar between groups. Use of loco-regional anesthetic modalities did not differ between groups. Daily numeric pain scores, opioid consumption, oxygen requirement, respiratory rate, and incentive spirometry recordings were similar between both groups. No benefit was observed when adding gabapentin to a multi-modal analgesic regimen for rib fractures. There were no instances of pneumonia, respiratory failure, or mortality in either group. Hospital and intensive care unit length of stay were similar between groups. Both overall and chest-specific quality of life was equivalent between groups at one month follow-up. CONCLUSIONS: In this group of critically ill patients with rib fractures, gabapentin did not improve acute outcomes for up to one month of treatment.
RCT Entities:
INTRODUCTION: Achieving adequate pain control for rib fractures remains challenging; prescription of alternatives to narcotics is imperative to curtail the current opioid epidemic. Although gabapentin has shown promise following elective thoracic procedures, its efficacy in patients with rib fractures remains unstudied. We hypothesized that gabapentin, as compared to placebo, would both improve acute pain control and decrease narcotic use among critically illpatients with rib fractures. MATERIALS AND METHODS: Adult patients admitted to the trauma surgery service from November 2016 - November 2017 at an urban, Level I trauma center with one or more rib fractures were randomized to either gabapentin 300 mg thrice daily or placebo for one month following their injury. Daily numeric pain scores, opioid consumption, oxygen requirement, respiratory rate, and incentive spirometry recordings during the index admission, as well as and one-month quality of life survey data were abstracted. RESULTS: Forty patients were randomized. The groups were well matched with respect to age, gender, prior narcotic use, tobacco use, and prior respiratory disease. Although the median RibScore did not differ between groups, the gabapentin group had a higher median number of ribs fractured as compared to the placebo group (7 vs. 5, respectively). Degree of pulmonary contusion and injury severity score were similar between groups. Use of loco-regional anesthetic modalities did not differ between groups. Daily numeric pain scores, opioid consumption, oxygen requirement, respiratory rate, and incentive spirometry recordings were similar between both groups. No benefit was observed when adding gabapentin to a multi-modal analgesic regimen for rib fractures. There were no instances of pneumonia, respiratory failure, or mortality in either group. Hospital and intensive care unit length of stay were similar between groups. Both overall and chest-specific quality of life was equivalent between groups at one month follow-up. CONCLUSIONS: In this group of critically illpatients with rib fractures, gabapentin did not improve acute outcomes for up to one month of treatment.
Authors: John A Harvin; Rondel Albarado; Van Thi Thanh Truong; Charles Green; Jon E Tyson; Claudia Pedroza; Charles E Wade; Lillian S Kao Journal: J Am Coll Surg Date: 2021-01-21 Impact factor: 6.113
Authors: Shakira W Burton; Christina Riojas; Gail Gesin; Charlotte B Smith; Vashti Bandy; Ronald Sing; Tamar Roomian; Meghan K Wally; Cynthia W Lauer Journal: J Trauma Acute Care Surg Date: 2022-03-01 Impact factor: 3.697
Authors: Kathleen E Wheeler; Ryan Grilli; John E Centofanti; Janet Martin; Celine Gelinas; Paul M Szumita; John W Devlin; Gerald Chanques; Waleed Alhazzani; Yoanna Skrobik; Michelle E Kho; Mark E Nunnally; Andre Gagarine; Begum A Ergan; Shannon Fernando; Carrie Price; John Lewin; Bram Rochwerg Journal: Crit Care Explor Date: 2020-07-06
Authors: John A Harvin; Van Thi Thanh Truong; Charles E Green; LaDonna Allen; Jason Murry; John J Radosevich; James N Bogert; Patrick B Murphy; Brandy B Padilla-Jones; Ben L Zarzaur; John R Taylor; Kevin W Sexton; Cassandra Decker; Thomas J Schroeppel; Charles E Wade; Lillian S Kao Journal: J Trauma Acute Care Surg Date: 2020-06 Impact factor: 3.697