Adjunctive Use of Gabapentinoids Increases Opioid Consumption Following One-Level to Three-Level Anterior Lumbar Interbody Fusion With Posterior Fixation: A Propensity Score-Matched Analysis.

Abstract

Retrospective cohort. To evaluate the impact of adjunctive gabapentinoid therapy on postoperative opioid consumption following one to three levels anterior lumbar interbody fusion (ALIF) with posterior fixation. Gabapentin and pregabalin are analogues of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) and are frequently used as adjuncts in multimodal anesthesia strategies for managing acute pain. However, the opioid-sparing effect of gabapentinoids in the context of spine surgery has yet to be consistently demonstrated. The PearlDiver database was queried from 2010 to 2021 for patients who underwent primary one to three levels ALIF with posterior fixation. Patients with opioid or gabapentinoid use within six months before index surgery were excluded. Patients with both gabapentinoid and opioid treatment were propensity score matched to patients with opioid-only treatment. The propensity score-matching resulted in two equal groups of 2617 patients with and without adjunctive gabapentinoid treatment for pain management. Adjunctive use of gabapentinoids was associated with a modest 2.9% reduction in average morphine milligram equivalent (MME) per day [standardized mean difference (SMD): -1.33, 95% CI: -2.657 to -0.002, P =0.050]. However, this was accompanied by a 37.1% increase in the total duration of opioid prescriptions (SMD: 94.97, 95% CI: 56.976-132.967, P <0.001) and a 41.7% increase in total MME consumption per patient (SMD: 4817.23, 95% CI: 1864.410-7770.044, P =0.001). In addition, gabapentinoid use was associated with an increased risk of readmission due to pain [relative risk (RR): 1.10, 95% CI: 1.002-1.212, P =0.050] and the development of drug abuse (RR: 1.37, 95% CI: 1.016-1.833, P =0.046). Despite the modest daily opioid-sparing effect observed, adjunctive gabapentinoid treatment appears to increase total opioid consumption due to prolonged opioid use and may compromise pain management in the context of ALIF with posterior fixation.