The effectiveness of perioperative gabapentin and ketamine in managing postoperative pain in adolescent idiopathic scoliosis patients undergoing spinal fusion surgery: A systematic review and meta-analysis

Introduction: Adolescent idiopathic scoliosis (AIS) is the most common spinal deformity in adolescents, affecting 2–3% of children aged 10–16 years. Severe cases often require posterior spinal fusion (PSF) to correct curvature and improve quality of life. Despite its effectiveness, PSF is associated with significant postoperative pain due to extensive spinal instrumentation and muscle dissection. Opioids remain the mainstay of analgesia but carry risks such as respiratory depression, nausea, and dependence. Increasingly, multimodal analgesic strategies are being explored to reduce opioid use. Among these, gabapentin and ketamine have shown promise as adjuvants for effective perioperative pain management in AIS. The aim of the study is to evaluate the utility of gabapentin and ketamine as adjuvants in adolescent idiopathic scoliosis patients undergoing posterior spinal fusion, with primary focus on postoperative opioid consumption (morphine equivalents) and associated complications.

Methods: Major electronic databases, including PubMed, MEDLINE, Embase, Google Scholar, and the Cochrane Library, were screened till December 2024 for randomized controlled trials (RCTs) and controlled cohort studies. Data was synthesized using the Review Manager 5.4 software using the generic inverse variance method and random model & reported in Standardized mean difference (SMD) and odds ratio (OR).

Results: Eleven studies comprising 520 patients indicated that children receiving gabapentin or ketamine required significantly lower morphine doses at 24 hours (SMD: -0.66; 95% confidence interval [CI]: -.92, -0.40; I² = 13% & SMD:-1.59; 95% CI:-3.09, -0.09; I² = 95 %, respectively) and 48 hours (SMD: -0.59; 95% CI: -0.88, -0.30; I² = 0%, SMD: -0.63; 95% CI: -1.61, 0.35; I² = 91%, respectively) compared to the control group. However, no significant differences were observed in terms of period of hospital stay (SMD: -0.10; 95% CI: -0.32, 0.13; I² = 0%, incidence of postoperative nausea & vomiting (OR: 0.40; 95% CI: 0.15, 1.06, I² = 56%).

Conclusions: Perioperative administration of gabapentin or ketamine significantly reduces opioid consumption within the first 48 hours following posterior spinal fusion in AIS patients.