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Use of Gabapentin in Posterior Spinal Fusion is Associated With Decreased Postoperative Pain and Opioid Use in Children and Adolescents

Trzcinski, Stacey, MD*; Rosenberg, Rebecca E., MD, MPH; Vasquez Montes, Dennis, MS; Sure, Akhila, BS; Zhou, Peter, BA; Tishelman, Jared, BA; Mansky, Robert, BS; McLeod, Lisa, MD, MSCE§; Tracy, Joanna, PharmD; Buckland, Aaron J., MD; Errico, Thomas J., MD

doi: 10.1097/BSD.0000000000000783

Study Design: Retrospective cohort study.

Objective: The objective of this study was to examine associations of gabapentin use with inpatient postoperative daily pain scores and opioid use in children undergoing PSF for AIS.

Summary of Background Data: Gabapentin use in posterior spinal fusion (PSF) postoperative pain management for adolescent idiopathic scoliosis (AIS) is increasingly common in order to decrease opioid use and improve pain control, though there is conflicting data on dosing and effectiveness to support this practice in real world settings.

Methods: Retrospective cohort study of children aged 10 to 21 years undergoing PSF for AIS between January 2013 and June 2016 at an urban academic tertiary care center. Adjuvant gabapentin exposure was defined as at least 15 mg/kg/d by postoperative day (POD) 1 with an initial loading dose of 10 mg/kg on day of surgery. Primary outcomes were daily postoperative mean pain score and opioid use [morphine milligram equivalents/kg/day(mme/kg/d)]. Secondary outcomes were short and long-term complications.

Results: Among 129 subjects (mean age, 14.6 y, 74% female, mean coronal cobb, 55.2 degrees), 24 (19%) received gabapentin. Unadjusted GABA exposure was associated with significantly lower opioid use on POD1 and 2 (49% and 31%mme/kg/d, respectively) and lower pain scores (14%) on POD2. Adjusting for preexisting back pain, preoperative coronal Cobb angle, and site, GABA use was associated with significantly lower mean pain scores on POD1 through POD3 (−0.68, P=0.01; −0.86, P=0.002; −0.63, P=0.04). Gabapentin use was also associated with decreased opioid use on POD1 and POD2 (−0.39mme/kg/d, P<0.001; −0.27, P=0.02). There was no difference in complications by gabapentin exposure.

Conclusions: Addition of gabapentin as adjuvant therapy for adolescent PSF, beginning on day of surgery, is associated with improved pain scores and decreased opioid use in the first 48 to 72 hours postoperatively.

Level of Evidence: This is a retrospective cohort study, classified as Level III under “Therapeutic Studies Investigating the Results of a Treatment.”

*Children’s National Medical Center, Washington, DC

Departments of Pediatrics

Orthopedics, NYU School of Medicine, New York, NY

§Children’s Hospital Colorado, Aurora, CO

NYU Langone Medical Center and Hospital for Joint Diseases, New York, NY

Drug Statement: The drug that is the subject of this manuscript is not FDA-approved for this indication.

The authors declare no conflict of interest.

Reprints: Rebecca E. Rosenberg, MD, MPH, Hassenfeld Children’s Hospital at NYU Langone, 424 E. 34th Street, New York, NY 10016 (e-mail:

Received April 24, 2018

Accepted January 3, 2019

© 2019 by Lippincott Williams & Wilkins, Inc.