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Gabapentin as part of a multimodal pain protocol for selective dorsal rhizotomy does not impact percentage of rootlets transected

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Abstract

Purpose

We aim to determine whether preoperatively initiated gabapentin for pain control impacts the percentage of rootlets cut during monitored, limited laminectomy selective dorsal rhizotomy (SDR) procedure.

Methods

This retrospective cohort study includes participants with cerebral palsy who had SDR for treatment of spasticity between 2010 and 2019 at a single-institution tertiary care center. One-level laminectomy SDR aimed to evaluate the cauda equina roots from levels L2-S1 with EMG monitoring. Gabapentin titration began 3 weeks prior to SDR. Data was analyzed using simple linear regression. Thirty-one individuals met inclusion criteria. Mean age was 7 years, 4 months. Eighteen participants (58%) identified as male, 12 (39%) female, and one (3%) non-binary. Thirty (97%) had bilateral CP. Sixteen (52%) were GMFCS II, four (13%) GMFCS III, five (16%) GMFCS IV, and six (19%) GMFCS V.

Results

Mean percentage of rootlets transected was 50.75% (SD 6.00, range 36.36–60.87). There was no relationship between the dose of gabapentin at time of SDR and percentage of rootlets cut with a linear regression slope of − 0.090 and an R2 of 0.012 (P = 0.56).

Conclusion

Results indicate that preoperative initiation of gabapentin did not impact the percentage of rootlets transected. Thus, gabapentin can be initiated prior to SDR at moderate dosages without impacting SDR surgical outcomes.

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Data availability

Deidentified data is available from the corresponding author on request.

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Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Division of Pediatric Rehabilitation Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Mary E. Lynch & Joline E. Brandenburg

  2. Department of Neurologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    David J. Daniels

  3. Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Mary E. Lynch & Joline E. Brandenburg

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  1. Mary E. Lynch
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Contributions

Dr. Joline Brandenburg and Dr. Mary Lynch contributed to concept and design. Data collection and analysis was performed by Dr. Mary Lynch. The first draft of the manuscript was written by Dr. Mary Lynch, and all authors (Dr. Mary Lynch, Dr. Joline Brandenburg, and Dr. David Daniels) commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Joline E. Brandenburg.

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Ethics approval and consent to participate

Our institution’s Institutional Review Board (IRB) approved this retrospective study and granted waiver of written informed consent/assent. Only participants whose parent/guardian had previously provided consent for their medical records to be used for research purposes were included.

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The authors have no competing interests to declare that are relevant to the content of this article.

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Lynch, M.E., Daniels, D.J. & Brandenburg, J.E. Gabapentin as part of a multimodal pain protocol for selective dorsal rhizotomy does not impact percentage of rootlets transected. Childs Nerv Syst 40, 487–494 (2024). https://doi.org/10.1007/s00381-023-06124-7

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