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

• Published in: Pediatric anesthesia 2018-06, Vol.28 (6), p.558-563
• Main Authors: Thomas, James J., Levek, Claire, Quick, Hannah D., Brinton, John T., Garg, Sumeet, Cohen, Mindy N.
• Format: Article
• Language: English
• Subjects: Adolescent; analgesics; Analgesics - therapeutic use; arthrodesis; Cohort Studies; Female; Gabapentin - therapeutic use; Goals; Humans; Male; Pain; pain management; Pain Management - methods; Pain, Postoperative - drug therapy; pediatrics; Physical therapy; Physical Therapy Modalities; rehabilitation; Retrospective Studies; Scoliosis; Scoliosis - rehabilitation; Scoliosis - surgery; spinal curvature; Spinal Fusion
• ISSN: 1155-5645; 1460-9592
• DOI: 10.1111/pan.13398

Summary Summary of Background Data Posterior spinal fusion surgery for scoliosis requires extensive postoperative analgesic care. In 2014, we initiated the use of gabapentin as an adjunct for multimodal pain management in spine fusion patients. The effect of gabapentin on postoperative recovery in scoliosis patients was evaluated using the time to meet postoperative physical therapy goals. This measure was chosen because the actions required to achieve the goals are specific and reproducible. Secondary outcomes included morphine equivalents and maximum pain scores. Aims The purpose of this study was to evaluate the effects of gabapentin on time to achieve physical therapy goals following posterior spinal fusion in adolescents with scoliosis. Methods A retrospective chart review was performed and patients treated perioperatively with gabapentin were compared with those who did not receive gabapentin. Outcome measures included the postoperative day that physical therapy goals were met, days to discharge, morphine equivalents, and maximum pain scores. The 4 physical therapy goals included logroll, transition from lying to sitting, ambulate 250 feet, and ascend/descend at least 3 stairs. Results There were 50 patients in the gabapentin group and 51 patients in the control group. In the gabapentin group, there was a statistically significant decrease in the time required to meet physical therapy goals. Notably, gabapentin was independently associated with a 5.34 times higher odds of completion of the most challenging physical therapy goal (stairs) within 1 day (P = .04; 95% CI=1.24‐37.44). There was not a statistically significant difference in length of hospital stay between the groups (P = .116; 95% CI=0‐1). Conclusion 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.