Gabapentin May Not Decrease Opioid Use in Pediatric Enhanced Recovery After Surgery Protocols

Hae Sung Kang; Travis M Sullivan; Rebecca Zee; Victoria G Kuester; Jason P Sulkowski

doi:10.1016/j.jss.2023.09.074

Gabapentin May Not Decrease Opioid Use in Pediatric Enhanced Recovery After Surgery Protocols

J Surg Res. 2023 Oct 27:294:169-175. doi: 10.1016/j.jss.2023.09.074. Online ahead of print.

Authors

Hae Sung Kang¹, Travis M Sullivan¹, Rebecca Zee², Victoria G Kuester³, Jason P Sulkowski⁴

Affiliations

¹ Department of Surgery, Virginia Commonwealth University, Richmond, Virginia.
² Department of Surgery, Virginia Commonwealth University, Richmond, Virginia; Division of Pediatric Urology, Children's Hospital of Richmond at VCU, Richmond, Virginia.
³ Division of Pediatric Orthopedics, Department of Orthopedic Surgery, Children's Hospital of Richmond at VCU, Richmond, Virginia.
⁴ Department of Surgery, Virginia Commonwealth University, Richmond, Virginia; Division of Pediatric Surgery, Children's Hospital of Richmond at VCU, Richmond, Virginia. Electronic address: Jason.sulkowski@vcuhealth.org.

PMID: 39492399
DOI: 10.1016/j.jss.2023.09.074

Abstract

Introduction: In adults, the use of gabapentin in Enhanced Recovery After Surgery (ERAS) protocols is associated with increased morbidity and clinically insignificant improvement in postoperative pain control. Furthermore, there are limited data supporting its use in pediatric ERAS protocols.

Methods: A single-institution retrospective study was performed to examine the correlation of gabapentin use and postoperative outcomes among children who underwent elective general, urologic, and orthopedic surgeries. Because gabapentin was removed from our institutional ERAS protocols in August 2020, we compared eligible patients from January 2018 to September 2021 using univariate and multivariable analysis. Due to heterogeneity between the treatment groups, a propensity score-matched analysis was also performed. Significance was defined as P < 0.05.

Results: In this study, 196 patients were included, with 91 (46.4%) who received gabapentin and 105 (53.6%) who did not. When used in combination with opioids, gabapentin was not associated with a reduction in the amount of opioids consumed (β = -0.4, 95% confidence interval = -1.9, 1.1). Instead, children who received gabapentin had increased odds of requiring oxygen supplementation (odds ratio = 3.1, 95% confidence interval = 1.2, 9.0), but this finding did not persist after propensity score-matched analysis.

Conclusions: The use of gabapentin in multimodal pain regimens in children following elective surgery was not associated with a decrease in postoperative narcotic use. Inclusion of gabapentin in perioperative pain medication protocols should be further evaluated with prospective studies.

Keywords: Enhanced recovery after surgery; Gabapentin; Pediatrics; Respiratory insufficiency.