Background: Older adults are particularly vulnerable to traumatic injuries. Gabapentin is frequently utilized as an adjunct analgesic in this population. This study aims to evaluate the impact of gabapentin on the incidence of delirium, pain scores, and opioid use in geriatric trauma patients.
Methods: Data from a tertiary level 1 trauma center was obtained from the trauma registry in addition to an internal self-service tool capable of querying medical healthcare records. Patients who were older than 65 years of age and were admitted between 05/2018 – 05/2023 were included. Data was processed using Python 3.12.3 and analysis was done using SAS software 9.4.
Results: A total of 4,660 patients were identified. We excluded 496 who denied research authorization, 634 with a Glasgow Coma Scale (GCS) score < 15 or missing, 623 who were taking gabapentin as a home medication, and 157 with a length of stay of 0 days or missing. Of the remaining 2,750 patients, 664 (24%) received gabapentin during hospitalization (GABA), while 2,086 (76%) did not (non-GABA). The median age was similar between groups : 77 years (65–103) for GABA and 80 years (65–103) for non-GABA. Length of hospital stay was significantly higher in the GABA group compared to the non-GABA group (mean 9± SD 13 days vs. 7±11 days, respectively. p<.0001). Delirium was documented in 53 patients (8%) in the GABA group and 161 (8%) in the non-GABA group (p = 0.8251). The odds of delirium increased by 1.6% for each 1000 mg unit increase in gabapentin dose, but results failed to reach statistical significance (OR=1.016, 95% CI: 0.988–1.044; p = 0.270). Mean pain scores were significantly lower in the GABA group compared to non-GABA at days 4–7 (3.6 ± 1.9, p = 0.0013), and days 8–14 (3.5 ± 2, p = 0.0056). When compared to non-GABA patients, fewer GABA patients required opioids at days 1–3 (74% vs. 62%, p < 0.0001), days 4–7 (66% vs. 49%, p < 0.0001), and days 8–14 (61% vs. 51%, p = 0.0057). Multivariable analysis adjusting for age, injury severity score, incident of rib fracture, chronic obstructive pulmonary disease, and length of stay showed that GABA patients had significantly lower pain scores and opioid use (p < 0.001).
Conclusions: In this cohort of older adult trauma patients, inpatient gabapentin use was associated with a significantly longer length of stay, lower pain scores, and reduced opioid consumption, without a statistically significant difference in delirium occurrence. These findings suggest that gabapentin may serve as a useful adjunct for pain management in this population.
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