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

Abstract

Background Gabapentin and intravenous patient-controlled analgesia (PCA) can reduce postoperative pain scores, postoperative opioid use, and time to completing physical therapy compared to PCA alone after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). Gabapentin combined with intrathecal morphine has not been studied. The primary purpose of this retrospective study was to evaluate whether perioperative gabapentin and intrathecal morphine provide more effective pain control than intrathecal morphine alone after PSF for AIS. Methods Patients aged 11 to 18 years who underwent PSF for AIS were identified. Patients who received intrathecal morphine only (ITM group) were matched by age and sex to patients who received intrathecal morphine and perioperative gabapentin (ITM+GABA group). The ITM+GABA group received gabapentin preoperatively and for up to 2 days postoperatively. Both groups received oxycodone and the same non-narcotic adjuvant medications. Results Our final study group consisted of 50 patients (25 ITM, 25 ITM+GABA). The ITM+GABA group had significantly lower mean total oxycodone consumption during the hospitalization (0.798 vs 1.036 mg/kg, P<0.015). While the ITM group had a lower mean pain score between midnight and 8 am on POD 1 (2.4 vs 3.7, P=0.026), pain scores were significantly more consistent throughout the postoperative period in ITM+GABA group. The ITM+GABA group experienced less nausea/vomiting (52% vs 84%, P=0.032) and pruritus (44% vs 72%, P=0.045). Time to physical therapy discharge and length of hospital stay were similar. Conclusion Addition of gabapentin resulted in reduced oral opioid consumption and more consistent postoperative pain scores after PSF for AIS. The patients who received intrathecal morphine and gabapentin also experienced a lower rate of nausea/vomiting and pruritus. Trial registration All data was collected retrospectively from chart review, with institutional IRB approval. Trial registration is not applicable.

Nausea and Vomiting After Posterior Spinal Fusion in Adolescent Idiopathic Scoliosis

“…A recent study of adult perioperative patients found that preoperative physical status is related to PONV and may be useful in risk stratification in pediatric patients 50 . Preoperative gabapentin is associated with a significant reduction in PONV among adult surgical patients 51 ; however, our review found its use to be of unclear benefit 40,41 . Preoperative supplementation with carbohydrates and/ or electrolytes has been shown to reduce PONV and acute phase response in pediatric patients undergoing general surgical or endoscopic procedures; this is currently being investigated in the AIS population [52][53][54] .…”

“…All patients received similar adjuvant pain medications. The rate of PONV was significantly lower in the group receiving gabapentin at 52% vs. 84% in the control group 40 .…”

Perioperative pain management for spine surgeries

“…ITM has been shown to provide effective analgesia for up to 24 h and reduce opioid consumption in the pediatric population, along with similar risks and side effects as seen in adult populations. [86][87][88][89] As spine surgeries in this population tend to be long and complex, administration of ITM by the surgeon at the end of the procedure should be considered to allow for the maximal effect in the postoperative period. 86 Also, as a precaution, consider monitoring these patients in the intensive care unit for respiratory depression, especially when receiving opioids through more than one route.…”

Postoperative analgesia for complex spinal surgery

“…The postoperative pain scores were not significantly different but were more consistent in the gabapentin group. There were also significantly lower rates of PONV and pruritus in the gabapentin group [22].…”