Efficacy of Perioperative Gabapentin Use in Patients with Idiopathic Scoliosis Undergoing Fusion Surgery: a Systematic Review and Meta-analysis

Overview

Journal Eur Spine J

Specialty Orthopedics

Date 2023 May 20

PMID 37209210

Authors

Jose Luis Bas

Paloma Bas

Fernando Bonilla

Gonzalo Mariscal

Silvia Perez

Miquel Bovea-Marco

Pedro Antonio Rubio-Belmar

Teresa Bas

Affiliations

Soon will be listed here.

Abstract

Purpose: This study aimed to assess whether the perioperative use of gabapentin was associated with decreased opioid use.

Methods: A meta-analysis was performed using PubMed, Embase, Scopus, and Cochrane Library. The randomized clinical trials included were focused on patients with adolescent idiopathic scoliosis who underwent posterior fusion surgery and were treated with gabapentin versus placebo medicine. The primary outcomes were opioid consumption at 24, 48, 72, and 96 h; time to introduction of oral medication, length of hospital stay, and period of urinary catheterization were also recorded. Data were combined using the Review Manager 5.4 software.

Results: Four randomized clinical trials with a pool of 196 adolescent patients (mean age: 14.8 ± 2.0 years) were included. At 24 and 48 h after surgery, opioid consumption was significantly lower in the gabapentin group: (standardized mean difference [SMD]: -0.50; 95% confidence interval [CI] - 0.79 to - 0.22) and (SMD: - 0.59; 95% CI - 0.88 to - 0.30), respectively. At 72 and 96 h, there were no significant differences between studies: (SMD: - 0.19; 95% CI - 0.52 to 0.13) and (SMD: 0.12; 95% CI - 0.25 to 0.50), respectively. Regarding the administration type, there were significant differences in favor of the 15 mg/kg subgroup with 600 mg at 48 h (SMD: - 0.69; 95% CI - 1.08 to - 0.30). There were no significant differences concerning the time to introduction of oral medication (MD: - 0.08; 95% CI - 0.39 to 0.23), hospitalization time (MD: - 0.12; 95% CI - 0.40 to 0.16), or period of urinary catheterization (SMD: - 0.27; 95% CI - 0.58 to 0.05).

Conclusions: Gabapentin decreased opioid consumption during the first 48 h. Doses of 15 mg/kg showed superiority in reducing opioid consumption in the first 48 h.

Level Of Evidence I: Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.

Citing Articles

Efficacy and Safety of Intravenous Magnesium Sulfate in Spinal Surgery: A Systematic Review and Meta-Analysis.

Campos J, Bas J, Campos C, Mariscal G, Bas T, Bas P J Clin Med. 2024; 13(11).

PMID: 38892833 PMC: 11172721. DOI: 10.3390/jcm13113122.

References

Lee C, Merchant S, Chidambaran V . Postoperative Pain Management in Pediatric Spinal Fusion Surgery for Idiopathic Scoliosis. Paediatr Drugs. 2020; 22(6):575-601. DOI: 10.1007/s40272-020-00423-1. View

Theroux J, Le May S, Fortin C, Labelle H . Prevalence and management of back pain in adolescent idiopathic scoliosis patients: A retrospective study. Pain Res Manag. 2015; 20(3):153-7. PMC: 4447159. DOI: 10.1155/2015/674354. View

Danielsson A, Nachemson A . Back pain and function 23 years after fusion for adolescent idiopathic scoliosis: a case-control study-part II. Spine (Phila Pa 1976). 2003; 28(18):E373-83. DOI: 10.1097/01.BRS.0000084267.41183.75. View

Zhang Y, Shao G, Zhang W, Li S, Niu J, Hu D . Gabapentin inhibits central sensitization during migraine. Neural Regen Res. 2014; 8(32):3003-12. PMC: 4146212. DOI: 10.3969/j.issn.1673-5374.2013.32.003. View

Mayer T, Neblett R, Cohen H, Howard K, Choi Y, Williams M . The development and psychometric validation of the central sensitization inventory. Pain Pract. 2011; 12(4):276-85. PMC: 3248986. DOI: 10.1111/j.1533-2500.2011.00493.x. View

Routray S, Pani N, Mishra D, Nayak S . Comparison of pregabalin with gabapentin as preemptive analgesic in lumbar spine surgery. J Anaesthesiol Clin Pharmacol. 2018; 34(2):232-236. PMC: 6066896. DOI: 10.4103/joacp.JOACP_12_17. View

Liberati A, Altman D, Tetzlaff J, Mulrow C, Gotzsche P, Ioannidis J . The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009; 6(7):e1000100. PMC: 2707010. DOI: 10.1371/journal.pmed.1000100. View

Guyatt G, Thorlund K, Oxman A, Walter S, Patrick D, Furukawa T . GRADE guidelines: 13. Preparing summary of findings tables and evidence profiles-continuous outcomes. J Clin Epidemiol. 2012; 66(2):173-83. DOI: 10.1016/j.jclinepi.2012.08.001. View

Anderson D, Duletzke N, Pedigo E, Halsey M . Multimodal pain control in adolescent posterior spinal fusion patients: a double-blind, randomized controlled trial to validate the effect of gabapentin on postoperative pain control, opioid use, and patient satisfaction. Spine Deform. 2020; 8(2):177-185. DOI: 10.1007/s43390-020-00038-z. View

10.

Li Y, Swallow J, Robbins C, Caird M, Leis A, Hong R . Gabapentin and intrathecal morphine combination therapy results in decreased oral narcotic use and more consistent pain scores after posterior spinal fusion for adolescent idiopathic scoliosis. J Orthop Surg Res. 2021; 16(1):672. PMC: 8594153. DOI: 10.1186/s13018-021-02525-z. View

11.

Mayell A, Srinivasan I, Campbell F, Peliowski A . Analgesic effects of gabapentin after scoliosis surgery in children: a randomized controlled trial. Paediatr Anaesth. 2014; 24(12):1239-44. DOI: 10.1111/pan.12524. View

12.

Rusy L, Hainsworth K, Nelson T, Czarnecki M, Tassone J, Thometz J . Gabapentin use in pediatric spinal fusion patients: a randomized, double-blind, controlled trial. Anesth Analg. 2010; 110(5):1393-8. DOI: 10.1213/ANE.0b013e3181d41dc2. View

13.

Turan A, Karamanlioglu B, Memis D, Hamamcioglu M, Tukenmez B, Pamukcu Z . Analgesic effects of gabapentin after spinal surgery. Anesthesiology. 2004; 100(4):935-8. DOI: 10.1097/00000542-200404000-00025. View

14.

Choudhry D, Brenn B, Sacks K, Shah S . Evaluation of Gabapentin and Clonidine Use in Children Following Spinal Fusion Surgery for Idiopathic Scoliosis: A Retrospective Review. J Pediatr Orthop. 2019; 39(9):e687-e693. DOI: 10.1097/BPO.0000000000000989. View

15.

Ghai A, Gupta M, Hooda S, Singla D, Wadhera R . A randomized controlled trial to compare pregabalin with gabapentin for postoperative pain in abdominal hysterectomy. Saudi J Anaesth. 2011; 5(3):252-7. PMC: 3168340. DOI: 10.4103/1658-354X.84097. View

16.

Pandey C, Priye S, Singh S, Singh U, Singh R, Singh P . Preemptive use of gabapentin significantly decreases postoperative pain and rescue analgesic requirements in laparoscopic cholecystectomy. Can J Anaesth. 2004; 51(4):358-63. DOI: 10.1007/BF03018240. View

17.

Dirks J, Fredensborg B, Christensen D, Fomsgaard J, Flyger H, Dahl J . A randomized study of the effects of single-dose gabapentin versus placebo on postoperative pain and morphine consumption after mastectomy. Anesthesiology. 2002; 97(3):560-4. DOI: 10.1097/00000542-200209000-00007. View

18.

Javaherforooshzadeh F, Amirpour I, Janatmakan F, Soltanzadeh M . Comparison of Effects of Melatonin and Gabapentin on Post Operative Anxiety and Pain in Lumbar Spine Surgery: A Randomized Clinical Trial. Anesth Pain Med. 2018; 8(3):e68763. PMC: 6119980. DOI: 10.5812/aapm.68763. View

19.

Savvides P, Gerdhem P, Grauers A, Danielsson A, Diarbakerli E . Self-Experienced Trunk Appearance in Individuals With and Without Idiopathic Scoliosis. Spine (Phila Pa 1976). 2019; 45(8):522-527. DOI: 10.1097/BRS.0000000000003308. View

20.

Escriva D, Moreno-Latorre E, Caplliure-Llopis J, Benet I, Barrios C . Relationship of Overweight and Obesity with Body Self-Image Dissatisfaction in Urban Mediterranean Adolescents. Int J Environ Res Public Health. 2021; 18(15). PMC: 8345661. DOI: 10.3390/ijerph18157770. View