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

Q2 Medicine

JSES International Pub Date : 2025-09-01 DOI:10.1016/j.jseint.2025.04.035

Julian Wier MD , Cory K. Mayfield MD , Kevin C. Liu MD , Eric H. Lin BA , Cailan L. Feingold BS , Alexander E. Weber MD , Seth C. Gamradt MD , Joseph N. Liu MD , Frank A. Petrigliano MD

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引用次数: 0

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

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术后高剂量加巴喷丁与全肩关节置换术后肺部并发症相关

背景加巴喷丁类药物越来越多地被用作全肩关节置换术（TSA）后的辅助镇痛药物。然而，数据表明，当与阿片类药物联合使用时，加巴喷丁类药物可能诱导镇静并可能增强呼吸抑制。本研究的目的是评估加巴喷丁术后肺部并发症和原发性TSA后阿片类药物总使用的影响。方法2016年1月1日至2020年12月31日期间接受了原发性、选择性解剖和反向TSA的患者，使用Premier Healthcare Database进行识别。计算术后第1天加巴喷丁的累积暴露量，并根据分布和常用的住院给药方案分为4组（“控制剂量”：0 mg，“低剂量”：1-300 mg，“中等剂量”：301-900 mg，“高剂量”>900 mg）。采用肺部并发症的校正优势比（aOR），建立多变量模型来评估加巴喷丁剂量与无加巴喷丁剂量的影响。评估两组间平均每日吗啡毫克当量（MMEs）。结果共发现86,137例TSA患者；其中，62,621例（72.70%）患者为对照组，12051例（13.99%）患者为低剂量组；中等剂量9465例（10.99%）；高剂量组2000例（2.32%）。与对照组相比，低剂量组（aOR: 1.15, 95%可信区间[CI]: 1.02-1.30）、中等剂量组（aOR: 1.17, 95% CI: 1.02-1.33）和高剂量组（aOR: 1.45, 95% CI: 1.15-1.82）患者发生肺部并发症的几率增加。平均每日MME为46.21±100.98；40.35±63.57；42.70±54.10；对照组、低、中、高剂量组分别为49.15±68.72毫克。结论TSA术后围手术期加巴喷丁暴露与术后肺部并发症风险增加独立相关。我们观察到总的MME摄入量没有显著的临床差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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