Higher postoperative gabapentin doses are associated with pulmonary complications after total shoulder arthroplasty

Gabapentinoids are increasingly being used as adjunctive analgesic medications after total shoulder arthroplasty (TSA). However, data suggest that when used in conjunction with opioids, gabapentinoids may induce sedation and possibly potentiate respiratory depression. The aim of this study was to evaluate the impact of gabapentin postoperative pulmonary complications and total opioid utilization after primary TSA.

Patients who underwent primary, elective anatomic and reverse TSA from January 1, 2016, to December 31, 2020, were identified using the Premier Healthcare Database. The cumulative postoperative day 1 gabapentin exposure was calculated and divided into four groups: ("Control Dose": 0 mg, "Low Dose": 1-300 mg, "Moderate Dose": 301-900 mg, and "High Dose" >900 mg) based on distribution and commonly used inpatient dosing regimens. Multivariable models were conducted to evaluate the effect of gabapentin doses compared to none using the adjusted odds ratio (aOR) of pulmonary complications. Average daily morphine milligram equivalents (MMEs) were evaluated between groups.

A total of 86,137 patients who underwent TSA were identified; of these, 62,621 (72.70%) patients comprised the Control cohort, while 12,051 (13.99%) were categorized into the Low Dose; 9,465 (10.99%) into the Moderate Dose; and 2,000 (2.32%) into the High Dose cohort. Compared to the patients in the Control cohort, those in the Low (aOR: 1.15, 95% confidence interval [CI]: 1.02-1.30), Moderate (aOR: 1.17, 95% CI: 1.02-1.33), and High Dose (aOR: 1.45, 95% CI: 1.15-1.82) had increased odds of pulmonary complications. Average daily MME was 46.21 ± 100.98; 40.35 ± 63.57; 42.70 ± 54.10; and 49.15 ± 68.72 milligrams in the Control, Low, Moderate, and High Dose cohorts, respectively.

Exposure to gabapentin during the perioperative period after TSA is independently associated with an increased risk of postoperative pulmonary complications. We observed no clinically significant differences in overall MME intake.