Postoperative Gabapentinoid use Reduces Long-Term Opioid Reliance After Long-Segment Lumbar Instrumentation

Study Design. A retrospective cohort analysis. Objective. This study investigates the association between initial postoperative gabapentinoid prescription and long-term opioid use following long-segment posterior lumbar instrumentation. Summary of Background Data. Gabapentinoids have gained traction for their neuropathic pain-relieving properties and potential synergy with opioids. However, their long-term efficacy in minimizing postoperative opioid consumption remains uncertain, particularly in patients undergoing extensive spinal surgery. Methods. The TriNetX Research Network was queried to identify patients with preoperative diagnoses of lumbar spinal stenosis, spondylolisthesis or scoliosis who underwent posterior lumbar instrumentation spanning 3 to 12 vertebral segments. The study population was stratified by based on the extent of instrumentation, defined as either 3-6 or 7-12 spinal segments. These patients were further divided into two cohorts: those who were prescribed a gabapentinoid (gabapentin or pregabalin) within 30 days postoperatively and those who were not. To address potential confounders, 1:1 propensity score matching (PSM) was performed, adjusting for demographics, comorbidities, and preoperative prescriptions of opioids and gabapentinoids. Presence of select postoperative opioid prescriptions were assessed at 1 to 3 months, 3 to 6 months, 6 to 12 months, and 12 to 24 months. Results: A total of 28,827 patients met all initial inclusion criteria. Following 1:1 PSM, the 3-6 segment group included 1,816 patients per cohort and the 7-12 segment group consisted of 344 patients per cohort. Among 3-6 level instrumentations, patients who received gabapentinoids within 30 days of surgery demonstrated significantly lower odds of being prescribed non-codeine-based and strong opioids at all postoperative intervals. In contrast, these gabapentinoid-treated patients exhibited higher odds of weak opioid prescriptions at 3 to 6 months. No statistically significant difference in opioid prescribing was observed among 7-12 segment instrumentation patients at any period. Conclusion. This study demonstrates that early postoperative gabapentinoid prescription is associated with a sustained reduction in chronic non-codeine-based and strong opioid use following 3-6 segment lumbar fusion. These findings underscore the utility of gabapentinoids as part of a multimodal analgesia strategy, potentially minimizing the need for more potent opioids and reducing the risk of long-term dependence in spine surgery patients.