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Multimodal pain control in adolescent posterior spinal fusion patients: a double-blind, randomized controlled trial to validate the effect of gabapentin on postoperative pain control, opioid use, and patient satisfaction

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Abstract

Study design

Prospective double-blind, randomized controlled trial.

Objectives

The objective of this study was to validate the efficacy of gabapentin as part of a multimodal pain regimen in a double-blind, randomized controlled trial for patients aged 10–19 years with idiopathic scoliosis undergoing posterior spinal fusion.

Summary of background data

Perioperative pain management represents a challenge for patients undergoing surgical correction of adolescent spinal deformity. Gabapentin has been shown to decrease postoperative pain and opioid use after spine surgery, but it has not yet been investigated as part of a multimodal pain regimen intended to decrease the perioperative use of opioids.

Methods

Fifty patients were randomized to receive gabapentin or placebo pre- and postoperatively in addition to a standardized medication regime including scheduled ketorolac and as-needed acetaminophen, hydromorphone, and oxycodone. Patients were monitored in the pre-, peri-, and postoperative periods for pain levels, medication dosing, side effects, adverse events, hospitalization length of stay, and parent satisfaction.

Results

There were statistically significant decreases in early postoperative pain scores and opioid use as well as total postoperative opioid use for the treatment group relative to controls. There were no statistically significant differences in adverse events, medication side effects, or hospitalization length. Parents of patients in both groups were very satisfied with the pain control provided to their children.

Conclusions

This randomized controlled trial demonstrates that pre- and postoperative administration of gabapentin as part of a multimodal pain management protocol significantly decreases both opioid use and visual analog pain scales in the first two postoperative days after posterior spinal fusion for adolescent idiopathic scoliosis. Gabapentin should be considered as a standard medication for perioperative pain control in this patient population.

Level of evidence

Level I.

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Acknowledgments

The authors thank Brandy Gonzalez and Jordan Cusick, research assistants with the OHSU Department of Pediatric Surgery, for their help in collecting and organizing clinical data. We also thank the perioperative and nursing staff at Doernbecher Children’s Hospital, who were diligent about incorporating the study protocol into their work. Finally, we thank the research pharmacy at OHSU, who randomized patients and formulated the study medication and placebo. No specific research funding was obtained for this project.

Funding

No specific funding was obtained for this investigation.

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Authors and Affiliations

  1. Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, OP31, Portland, OR, 97239-3098, USA

    Devon E. Anderson, Nicholas T. Duletzke & Matthew F. Halsey

  2. Department of Orthopaedics and Rehabilitation, University of Rochester, 601 Elmwood Ave, Box 665, Rochester, NY, 14642, USA

    Devon E. Anderson

  3. Department of Surgery, University of Utah, 30 N 1900 E, Salt Lake City, UT, 84112, USA

    Nicholas T. Duletzke

  4. Department of Pediatric Anaesthesiology, Doernbecher Children’s Hospital, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239-3098, USA

    Elizabeth B. Pedigo

Authors
  1. Devon E. Anderson
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  2. Nicholas T. Duletzke
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  3. Elizabeth B. Pedigo
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  4. Matthew F. Halsey
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Corresponding author

Correspondence to Matthew F. Halsey.

Ethics declarations

Conflict of interest

DEA (none), NTD (none), EBP (none), MFH (none).

Ethical standards

This study received institutional IRB approval (IRB no. 9681) and was registered with ClinicalTrials.org (NCT01977937) before patient enrollment.

IRB approval

This study received institutional IRB approval (IRB no. 9681) and was registered with ClinicalTrials.org (NCT01977937) before patient enrollment.

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Anderson, D.E., Duletzke, N.T., Pedigo, E.B. et al. Multimodal pain control in adolescent posterior spinal fusion patients: a double-blind, randomized controlled trial to validate the effect of gabapentin on postoperative pain control, opioid use, and patient satisfaction. Spine Deform 8, 177–185 (2020). https://doi.org/10.1007/s43390-020-00038-z

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  • DOI: https://doi.org/10.1007/s43390-020-00038-z

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