Gabapentin use in pediatric spinal fusion patients: a randomized, double-blind, controlled trial.
BACKGROUND
Gabapentin has opioid-sparing effects in adult surgical patients, but no reported studies have involved children and adolescents. In a double-blind, randomized, controlled trial, we examined whether gabapentin decreases postoperative opioid consumption for pediatric spinal fusion patients with idiopathic scoliosis.


METHODS
Patients, aged 9 to 18 years, received preoperative gabapentin (15 mg/kg, treatment) or placebo. Anesthesia was standardized. After surgery, all patients received standardized patient-controlled analgesia opioid and continued on either gabapentin (5 mg/kg) or placebo 3 times per day for 5 days. Opioid use was calculated in mg/kg/time intervals. Pain scores and opioid side effects were recorded.


RESULTS
Data from 59 patients (30 placebo and 29 gabapentin) did not differ in demographics. Total morphine consumption (mg/kg/h +/- SD) was significantly lower in the gabapentin group in the recovery room (0.044 +/- 0.017 vs 0.064 +/- 0.031, P = 0.003), postoperative day 1 (0.046 +/- 0.016 vs 0.055 +/- 0.017, P = 0.051), and postoperative day 2 (0.036 +/- 0.016 vs 0.047 +/- 0.019, P = 0.018). In addition, gabapentin significantly reduced first pain scores in the recovery room (2.5 +/- 2.8 vs 6.0 +/- 2.4, P < 0.001) and the morning after surgery (3.2 +/- 2.6 vs 5.0 +/- 2.2, P < 0.05), but otherwise pain scores were not significantly different. There were no differences in opioid-related side effects over the course of the study.


CONCLUSIONS
Perioperative oral gabapentin reduced the amount of morphine used for postoperative pain after spinal fusion surgery, but not overall opioid-related side effects. Initial pain scores were lower in the treatment group. Perioperative use of gabapentin seems to be an effective adjunct to improve pain control in the early stages of recovery in children and adolescents undergoing spinal fusion.
Rusy
Lynn M
LM
Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, USA. lrusy@mcw.edu
Hainsworth
Keri R
KR
Nelson
Tom J
TJ
Czarnecki
Michelle L
ML
Tassone
J Channing
JC
Thometz
John G
JG
Lyon
Roger M
RM
Berens
Richard J
RJ
Weisman
Steven J
SJ
D000208:Acute Disease; D000293:Adolescent; D000588:Amines / Q000627:therapeutic use*; D016058:Analgesia, Patient-Controlled; D000700:Analgesics / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D000077206:Gabapentin; D006801:Humans; D008297:Male; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D012600:Scoliosis / Q000601:surgery; D013123:Spinal Fusion; D016896:Treatment Outcome; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use*
D000588:Amines; D000700:Analgesics; D000701:Analgesics, Opioid; D003509:Cyclohexanecarboxylic Acids; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D009020:Morphine