Holmes, A., Illowsky, B., & Dean, S. (2017) state that in order to test anything one has to start with two hypothesis. The Null, Ho, is what you expect things are and if not, something has to happen. The Secondary hypothesis, Ha, is the opposite hypothesis and must have a preponderance of evidence proving for it to negate the Null. In my program, ERAS we have spent three years using the Null hypothesis that regularly prescribed Gabapentinoids help lesson post-operative pain and usage of Opioids. The Ha, alternative is that Gabapentinoids do not lesson post-operative pain and the usage of opioids.
For three years, we have had Gabapentionoids as a cornerstone in our multi-modal pain regimen, as did many ERAS programs. We gave Lyrica or Gabapentin prior to going into the OR and then for the length of stay. Recently our head Attending decided to discontinue the practice based on a couple of reviews including this systematic review and meta-analysis by Verret M.D., M.Sc. et al., (2020), while reviewing 281 controlled studies of Gabapentinoid usage with controls showed no meaningful difference in pain control but did show a greater incidence in dizziness, visual disturbances, respiratory depression and addiction. This fell in line with the data we have tracked in our proprietary app and impressions during treatment of patients. Therefor Dr. Galay changing protocol was the, Cannot accept Ho.
Holmes, A., Illowsky, B., & Dean, S. (2017). Introductory business statistics. Houston, TX: OpenStax College, Rice University.
Verret M.D., M.Sc, M., Zarychanski, M.D., M.Sc., R., Perron, M.Sc., C., Savard,M.D., candidate, X., Pinard,M.D., M.Sc., A., Turgeon, M.D., M.Sc, A. F., . . . Leblanc, M.D., M.Sc., G. (2020). Perioperative Use of Gabapentinoids for the Management of Postoperative Acute Pain. Anesthesiology, 133(2), 265-279. doi:10.1097/ALN.0000000000003428
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