Sustained postoperative gabapentinoids do not result in clinically important decreases in postoperative delirium, pain, or opioid dose in gabapentin naïve lumbar fusion patients.
7 affiliations
- 1Department of Neurosurgery, University of Iowa Roy J. and Lucille A. Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, United States.
- 2Department of Epidemiology, University of Iowa College of Public Health, 145 North Riverside Drive, Iowa City, IA 52242, United States.
- 3Department of Orthopedics and Rehabilitation, University of Iowa Roy J. and Lucille A. Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, United States.
- 4Department of Anesthesia, University of Iowa Roy J. and Lucille A. Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, United States.
- 5Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, B6/319, CSC, Madison, WI 53792, United States.
- 6Central Clinical School and National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Lifehouse BuildingLevel 6, 119-143 Missenden Road, Camperdown New South Wales 2006, Australia.
- 7Department of Anesthetics, Royal Prince Alfred Hospital, Institute of Academic Surgery, Level 4 Main Building, Missenden Road, Camperdown New South Wales 2050, Australia.
Abstract
By decreasing postoperative pain and opioids, sustained postoperative gabapentinoids might decrease delirium after spine surgery. Prior randomized trials of sustained postoperative gabapentinoids after spine surgery have either not assessed delirium or excluded preoperatively opioid tolerant patients. The aim of this study was to determine in older lumbar fusion patients who were not prescribed preoperative gabapentinoids if sustained postoperative gabapentinoids affected postoperative delirium, pain, and opioid dose. An electronic medical record search of an academic medical center identified 303 posterior lumbar fusion patients (age ≥65 years) not prescribed preoperative gabapentinoids who received gabapentinoids starting on postoperative day 1 (n = 184) or did not (n = 119) Propensity score-weighted models and Bayesian analysis determined the effects of postoperative gabapentinoids on postoperative delirium, pain, and opioid dose. The median postoperative gabapentin dose equivalent was 900 mg/d. The delirium hazard ratio (HR) was not significantly greater in the gabapentin group: 1.40 (95% credible interval [CrI] 0.66-2.23), but with only a 4% probability that gabapentin decreased delirium (HR ≤ 0.8) vs. a 65% probably that gabapentin increased delirium (HR ≥ 1.2). The daily average pain score was not significantly less in the gabapentin group: -0.11 points out of 10 (95% CrI -0.41 to 0.18), with a 0% probability that the minimum clinically important difference (MCID) of -1 point was attained. The daily opioid dose was statistically significantly less in the gabapentin group: -10.2 mg/d (95% CrI -18.8 to -2.1), but with a 0% probability that the MCID of -30 mg/d was attained. In older lumbar fusion surgery patients who were not prescribed preoperative gabapentinoids, sustained postoperative gabapentinoids did not significantly affect delirium incidence and did not result in clinically important decreases in pain or opioid dose. Our results suggest gabapentinoids may be more likely to increase delirium than to decrease it.
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BibTeX
@article{ray2026sustained,
title = {{Sustained postoperative gabapentinoids do not result in clinically important decreases in postoperative delirium, pain, or opioid dose in gabapentin naïve lumbar fusion patients.}},
author = {Emanuel J Ray and Eli A Perez and Ryan M Carnahan and Catherine R Olinger and Royce W Woodroffe and Brian J Park and Colin J Gold and Rashmi N Mueller and Matthew I Banks and Robert D Sanders and Bradley J Hindman},
journal = {North American Spine Society journal},
year = {2026},
month = oct,
doi = {10.1016/j.xnsj.2026.100956},
url = {https://europepmc.org/article/MED/42999566},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Sustained postoperative gabapentinoids do not result in clinically important decreases in postoperative delirium, pain, or opioid dose in gabapentin naïve lumbar fusion patients.
AU - Emanuel J Ray
AU - Eli A Perez
AU - Ryan M Carnahan
AU - Catherine R Olinger
AU - Royce W Woodroffe
AU - Brian J Park
AU - Colin J Gold
AU - Rashmi N Mueller
AU - Matthew I Banks
AU - Robert D Sanders
AU - Bradley J Hindman
PY - 2026
DA - 2026/10/11
JO - North American Spine Society journal
DO - 10.1016/j.xnsj.2026.100956
UR - https://europepmc.org/article/MED/42999566
AB - By decreasing postoperative pain and opioids, sustained postoperative gabapentinoids might decrease delirium after spine surgery. Prior randomized trials of sustained postoperative gabapentinoids after spine surgery have either not assessed delirium or excluded preoperatively opioid tolerant patients. The aim of this study was to determine in older lumbar fusion patients who were not prescribed preoperative gabapentinoids if sustained postoperative gabapentinoids affected postoperative delirium, pain, and opioid dose. An electronic medical record search of an academic medical center identified 303 posterior lumbar fusion patients (age ≥65 years) not prescribed preoperative gabapentinoids who received gabapentinoids starting on postoperative day 1 (n = 184) or did not (n = 119) Propensity score-weighted models and Bayesian analysis determined the effects of postoperative gabapentinoids on postoperative delirium, pain, and opioid dose. The median postoperative gabapentin dose equivalent was 900 mg/d. The delirium hazard ratio (HR) was not significantly greater in the gabapentin group: 1.40 (95% credible interval [CrI] 0.66-2.23), but with only a 4% probability that gabapentin decreased delirium (HR ≤ 0.8) vs. a 65% probably that gabapentin increased delirium (HR ≥ 1.2). The daily average pain score was not significantly less in the gabapentin group: -0.11 points out of 10 (95% CrI -0.41 to 0.18), with a 0% probability that the minimum clinically important difference (MCID) of -1 point was attained. The daily opioid dose was statistically significantly less in the gabapentin group: -10.2 mg/d (95% CrI -18.8 to -2.1), but with a 0% probability that the MCID of -30 mg/d was attained. In older lumbar fusion surgery patients who were not prescribed preoperative gabapentinoids, sustained postoperative gabapentinoids did not significantly affect delirium incidence and did not result in clinically important decreases in pain or opioid dose. Our results suggest gabapentinoids may be more likely to increase delirium than to decrease it.
SN - 2666-5484
ER -