Chronic Gabapentinoid Use and Lumbar Fusion Outcomes: A Comparative Analysis of Gabapentinoids Alone and in Combination With Opioids.

Abstract

Retrospective comparative cohort study. To examine the effects of chronic use of gabapentinoids (GPs) (alone or with opioids) on the outcomes of lumbar fusions. Opioids have historically been the mainstay medications for pain management, but the ongoing opioid epidemic led physicians to look for alternatives. GPs are used for various indications, and chronic use for any indication may lead to a higher risk of adverse events, especially when combined with opioids. Patients aged 18 years and older who underwent posterior fusion of the lumbosacral spine and ≥1-year follow-up were included. Patients were grouped according to their preoperative chronic GP and opioid usage as GP and opioid nonuser (-/-), GP user opioid nonuser (+/-), GP nonuser and opioid user (-/+), and GP and opioid user (+/+). A total of 563 patients (M/F%=41/59, mean age 61.1 y) were included. Two hundred eighty (49%) patients were in the group -/-, while 110 (19%) were in +/-, 78 (15%) were in -/+, and 95 (17%) were in +/+. For ODI, back pain and leg pain, +/+ had the worst outcomes at all time points, while -/- had the best. Chronic GP users (+/-) showed back pain improvement similar to the -/- group; however, the improvements in leg pain and ODI were considerably less. GP use resulted in increased postoperative opioid requirements, although not as much as chronic opioid use. Complication rates were similar. Chronic preoperative use of GPs may lead to inferior outcomes when compared with GP-naive patients, and this is significantly accentuated when taken concurrently with opioids. Patients who are using both GPs and opioids had the worst results for almost every outcome measure. Given the significantly worse surgical outcomes documented in this study, concurrent use with opioids should be avoided.