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Published on: June 10, 2013
Does Gabapentin Use Following ACDF Decrease Opioid Utilization? A Retrospective Propensity-Matched Analysis Conducted
Mark Miller1, Hunter Smith1, Omar Sbaih2
1Department of Orthopaedic Surgery, Jefferson Health NJ, Stratford, NJ, USA.
Global Spine Journal
|March 20, 2026
Summary
Postoperative gabapentinoid use after anterior cervical discectomy and fusion (ACDF) was linked to increased opioid consumption and higher complication rates, including pneumonia and respiratory failure. These findings challenge the presumed benefits of gabapentinoids in ACDF pain management.
Area of Science:
- Neurosurgery
- Anesthesiology
- Pharmacology
Background:
- Optimal postoperative pain control and reduced opioid use are critical after spine surgery, particularly anterior cervical discectomy and fusion (ACDF).
- Gabapentinoids are commonly used for neuropathic pain and possess neuroprotective properties, but their role in multimodal analgesia following ACDF remains unclear.
Purpose of the Study:
- To investigate the association between postoperative gabapentinoid administration and subsequent opioid use in patients undergoing ACDF.
- To evaluate the impact of gabapentinoids on surgical and systemic complication rates in the ACDF population.
Main Methods:
- A retrospective cohort study utilizing the TriNetX Research network identified adult patients who underwent ACDF between 2003 and 2023.
- Patients were propensity score-matched (1:1) into groups receiving postoperative gabapentinoids versus acetaminophen monotherapy, excluding those with prior chronic opioid use.
- Outcomes, including opioid utilization and complications, were assessed at multiple follow-up intervals (30 days to 5 years) using risk ratios and Kaplan-Meier analyses.
Main Results:
- The analysis included 32,455 patients per group post-matching.
- Gabapentinoid use was significantly associated with higher opioid consumption across all follow-up periods, persisting up to 5 years (RR 4.61, P < 0.001).
- Patients receiving gabapentinoids exhibited an increased risk of pneumonia and respiratory failure, with durable separation observed in Kaplan-Meier curves for these outcomes and opioid use (all log-rank P < 0.001).
Conclusions:
- Postoperative gabapentinoid use following ACDF is associated with increased opioid utilization and elevated complication rates, contrary to presumed benefits.
- These findings suggest that gabapentinoids may not be an effective component of multimodal pain management strategies for ACDF patients.
- Further research is warranted to explore alternative analgesia protocols for ACDF to optimize pain control while minimizing opioid dependence and complications.
