Utility of gabapentin in meeting physical therapy goals following posterior spinal fusion in adolescent patients with idiopathic scoliosis

Abstract

In this retrospective analysis, the use of perioperative gabapentin is associated with a statistically significant decrease in time to completing physical therapy goals after spinal fusion for adolescent idiopathic scoliosis.

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

“…While Thomas et al found a decrease in time to complete physical therapy goals when patients received perioperative gabapentin combined with intravenous PCA, only 28% of those patients ambulated on POD 1, 52% of those patients completed all physical therapy goals on POD 2, and mean length of hospital stay was 3 days. 4 Similarly, in Choudhry et al's study, the gabapentin and gabapentin plus clonidine groups had a mean time to ambulation of 36 hours and 27 hours, and a mean length of hospital stay of 87 hours and 77 hours, respectively. 1 Prior studies have shown no difference in the rate of adverse events, including postoperative nausea/vomiting, pruritus, and oversedation, with the addition of perioperative gabapentin to intravenous PCA after PSF for AIS.…”

“…5 Thomas et al demonstrated a decrease in time to complete physical therapy goals when patients received perioperative gabapentin but there was no difference in length of hospital stay. 4 Choudhry et al retrospectively showed that PSF patients who received perioperative gabapentin combined with intravenous PCA had decreased total PCA doses, decreased morphine use on POD 1, and shorter time to transition to orals compared to patients who received PCA alone. 1 However, postoperative pain scores, time to ambulation, and length of hospital stay were similar.…”

“…We found wide variability in gabapentin dosing in published reports on perioperative gabapentin combined with intravenous PCA in PSF patients with AIS. 1,[3][4][5]17 We hope that the retrospective data we have collected will allow us to implement a standard perioperative gabapentin protocol for all patients undergoing PSF for AIS at our institution and we have since worked with our operating room pharmacy to increase the availability of liquid gabapentin in the preoperative area. Another limitation is the small sample size.…”

“…Multimodal pain management has been found to improve the quality of analgesia and reduce medication-related side effects after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). [1][2][3][4][5][6][7] Prior studies have shown that perioperative gabapentin, an effective drug for neuropathic pain, combined with intravenous patient-controlled analgesia (PCA) reduces initial postoperative pain scores, postoperative opioid use, and time to completing physical therapy goals compared to PCA alone after PSF for AIS. 1,3−5 Postoperative pain is not a Food and Drug Administration-approved indication for gabapentin usage.…”

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

“…Similarly, Trzcinski et al retrospectively found that patients who received perioperative gabapentin had improved pain scores and decreased opioid use for 48 to 72 h after surgery [ 5 ]. Thomas et al demonstrated a decrease in time to complete physical therapy goals when patients received perioperative gabapentin but there was no difference in length of hospital stay [ 4 ].…”