Serotonin-norepinephrine reuptake inhibitor and gabapentinoid use independently predict greater postoperative opioid consumption in lumbar fusion patients.

Authors

• Rajkishen Narayanan
• Jonathan Dalton
• Michael A McCurdy
• Tariq Z Issa
• Robert J Oris
• Alexa Tomlak
• Yunsoo Lee
• Kenneth McCall
• Dodger Norceide
• John J Mangan
• Mark F Kurd
• Ian David Kaye
• Jose A Canseco
• Alan S Hilibrand
• Alexander R Vaccaro
• Christopher K Kepler
• Gregory D Schroeder

Publication/Presentation Date

6-1-2025

Abstract

PURPOSE: Treatment of preoperative depression has been shown to reduce pain perception and disability after spine surgery, which encouraged utilizing antidepressants as a treatment for pain. Though opioid consumption after spine surgery has been well studied, few studies have investigated its association with medications such as antidepressants and gabapentinoids. Therefore, our study investigated the relationship between antidepressants, gabapentinoids and opioid consumption after lumbar fusion.

METHODS: After Institutional Review Board (IRB) approval, patients undergoing elective lumbar fusion from 2017 to 2021 at a single, academic, tertiary care center were identified. Patients were determined to be taking an antidepressant or gabapentinoid if they had these medications listed as active in their preoperative and first postoperative appointments. Opioid consumption before and after surgery was collected through the state Prescription Drug Monitoring Program (PDMP). Statistics were performed to compare patients across groups.

RESULTS: 411 patients were identified that underwent elective lumbar fusion with complete patient-reported outcomes and PDMP data. On multivariable analysis, preoperative morphine milligram equivalents (MMEs) were an independent predictor of postoperative MME/day at all postoperative time points. Perioperative SNRI use was predictive of increased 90-180 day MME/day (p = 0.019). Perioperative gabapentinoid use was predictive of increased MME/day at 30-90 days (p = 0.034) and 180-365 days (p = 0.024).

CONCLUSION: A complex relationship exists between the medical management of mood disorders and neuropathic pain using antidepressants, anxiolytics, and gabapentinoids for patients undergoing spinal surgery. Patients prescribed gabapentinoids and SNRIs are at increased risk of opioid use postoperatively while patients taking SSRIs do not demonstrate such increased risk.

Volume

34

Issue

6

First Page

2445

Last Page

2452

ISSN

1432-0932

Published In/Presented At

Narayanan, R., Dalton, J., A McCurdy, M., Z Issa, T., Oris, R. J., Tomlak, A., Lee, Y., McCall, K., Norceide, D., Mangan, J. J., F Kurd, M., Kaye, I. D., Canseco, J. A., Hilibrand, A. S., Vaccaro, A. R., Kepler, C. K., & Schroeder, G. D. (2025). Serotonin-norepinephrine reuptake inhibitor and gabapentinoid use independently predict greater postoperative opioid consumption in lumbar fusion patients. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 34(6), 2445–2452. https://doi.org/10.1007/s00586-025-08764-6

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

40244431

Department(s)

Administration and Leadership

Document Type

Article