Gabapentin for Postoperative Pain Management in Lumbar Fusion Surgery

Study DesignRetrospective cohort study ObjectivesTo investigate the effect of perioperative gabapentin administration on postoperative pain and opioid use in elderly patients after elective posterior lumbar fusion. MethodsThis was a single-center study of patients over the age of 65 who underwent elective posterior lumbar fusion. The cohort was stratified into two groups based on perioperative gabapentin administration defined as use both in the immediate preoperative period and postoperatively during hospitalization. Mean daily visual analogue scale (VAS) pain scores and mean daily morphine equivalent dosage (MED) during the postoperative hospital stay were compared between these groups using traditional regression and inverse probability weighting. ResultsThere were 350 patients who received gabapentin perioperatively and 78 patients who did not receive gabapentin. Multivariate regression did not demonstrate a difference in daily MED ({beta}=-6.6 mg, p=0.816) or daily pain scores ({beta}=0.04, p=0.257) averaged over the first seven postoperative days. Sub-analysis stratifying by each individual postoperative day also did not demonstrate a difference in MED or pain scores. ConclusionThis study did not find perioperative gabapentin administration to be beneficial in reducing postoperative VAS pain scores or opioid use in the acute postoperative period for elderly patients undergoing posterior lumbar fusion. These findings are consistent with recent literature suggesting gabapentin is of minimal benefit in postoperative multimodal analgesia regimens. Level of Evidence3