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Gabapentin as a novel adjunct for postoperative irritability after superior cavopulmonary connection operation in children

Published online by Cambridge University Press:  03 May 2024

Celine Thibault Open the ORCID record for Celine Thibault [Opens in a new window] ,
E. Zachary Ramsey ,
Hailey Collier ,
Di Shu Open the ORCID record for Di Shu [Opens in a new window] ,
Jennifer Faerber ,
Emily Schwartz ,
Jonathan Chen ,
David J. Goldberg ,
Nadir Yehya Open the ORCID record for Nadir Yehya [Opens in a new window]  and
Monique M. Gardner Open the ORCID record for Monique M. Gardner [Opens in a new window]
Celine Thibault*
Affiliation:
Department of Anesthesiology and Critical Care, Children’s Hospital of Philadelphia, Philadelphia, PA, USA Department of Pediatrics, Université de Montréal, Montreal, QC, Canada Division of Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada
E. Zachary Ramsey
Affiliation:
Department of Pharmacy Services, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Hailey Collier
Affiliation:
Department of Pharmacy Services, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Di Shu
Affiliation:
Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA The Clinical Futures, Research Institute, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Jennifer Faerber
Affiliation:
Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Emily Schwartz
Affiliation:
Division of Cardiology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
Jonathan Chen
Affiliation:
Division of Cardiothoracic Surgery, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
David J. Goldberg
Affiliation:
Division of Cardiology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
Nadir Yehya
Affiliation:
Department of Anesthesiology and Critical Care, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Monique M. Gardner
Affiliation:
Department of Anesthesiology and Critical Care, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
*
Corresponding author: C. Thibault; Email: celine.thibault@umontreal.ca
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Abstract

Objectives:

Describing our institution’s off-label use of gabapentin to treat irritability after superior cavopulmonary connection surgery and its impact on subsequent opiate and benzodiazepine requirements.

Methods:

This is a single-center retrospective cohort study including infants who underwent superior cavopulmonary connection operation between 2011 and 2019.

Results:

Gabapentin was administered in 74 subjects (74/323, 22.9%) during the observation period, with a median (IQR) starting dose of 5.7 (3.3, 15.0) mg/kg/day and a maximum dose of 10.7 (5.5, 23.4) mg/kg/day. Infants who underwent surgery in 2015–19 were more likely to receive gabapentin compared with those who underwent surgery in 2011–14 (p < 0.0001). Infants prescribed gabapentin were younger at surgery (137 versus 146 days, p = 0.007) and had longer chest tube durations (1.8 versus 0.9 days, p < 0.001), as well as longer postoperative intensive care (5.8 versus 3.1 days, p < 0.0001) and hospital (11.5 versus 7.0 days, p < 0.0001) lengths of stays. The year of surgery was the only predisposing factor associated with gabapentin administration in multivariate analysis. In adjusted linear regression, infants prescribed gabapentin on postoperative day 0–4 (n = 64) had reduced benzodiazepine exposure in the following 3 days (−0.29 mg/kg, 95% CI −0.52 – −0.06, p = 0.01) compared with those not prescribed gabapentin, while no difference was seen in opioid exposure (p = 0.59).

Conclusions:

Gabapentin was used with increasing frequency during the study period. There was a modest reduction in benzodiazepine requirements associated with gabapentin administration and no reduction in opioid requirements. A randomised controlled trial could better assess gabapentin’s benefits postoperatively in children with congenital heart disease.

Keywords

Glennpostoperative carepaincongenital heart diseaseuniventricular heartcardiac surgery
Type
Original Article
Information
Cardiology in the Young , First View , pp. 1 - 7
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Copyright
© The Author(s), 2024. Published by Cambridge University Press

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