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

Introduction: The opioid epidemic led physicians to look for alternative pain management options. Gabapentinoids (GPs) are effective for neuropathic pain, but chronic use may lead to adverse events, especially when combined with opioids. This study examines the effects of chronic GP use (alone or with opiods) on lumbar fusion outcomes.

Methods: Patients ≥18 years who had a posterior lumbar fusion and ≥1 year follow-up were included and grouped based on their preop chronic (>3 months) GP and opioid use: GP and opioid non-user (-/-), GP user, opioid non-user (+/-), GP non-user, opioid user (-/+) and GP and opioid user (+/+).

Results: 563 patients (M/F=41/59, mean age 61.1 years) were included. 280 (49%) were -/-; 110 (19%) were +/-, 78 (15%) were -/+ and 95 (17%) were +/+. For ODI, BP and LP, +/+ had the worst outcomes at all time points, while -/- had the best. Chronic GP users (+/-) showed BP improvement similar to the -/- group, but improvements in LP and ODI were less. GP users had higher postop opioid use, although not as much as chronic opioid users.
Total opioid consumption was highest for GP and opioid users (+/+). The number of patients still taking opioids was highest for GP and opioid users (+/+) at each time point postop. Complications rates were comparable, but readmissions was highest for chronic GP and opioid users (+/+). LOS was significantly shorter in the -/- group.

Conclusion : Chronic preop GP use may lead to inferior outcomes compared to GP-naïve patients, and is accentuated with concurrent opioid use. Patients using both GPs and opioids had the worst results for almost every outcome measure. Chronic GP use may be necessary for patients with severe neuropathic pain, but worse surgical outcomes should be anticipated with lumbar fusion. Concurrent use with opioids should be avoided if possible.