Abstract 13442: Gabapentin as a Novel Adjunct for Postoperative Management After Superior Cavopulmonary Connection Operation in Children

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Introduction: For infants with single ventricle congenital heart disease, the superior cavopulmonary connection (SCPC) stabilizes pulmonary blood flow but is associated with elevated pressure in the superior vena cava (SVC), often leading to irritability. We describe the off-label use of gabapentin for the treatment of irritability after SCPC. Methods: We reviewed our patients who underwent SCPC between 2011-2019. Patients were prescribed gabapentin at provider discretion. Total medication doses during the first seven postoperative days were aggregated in morphine and midazolam equivalents. For those who received gabapentin, maximum dose and use of post-discharge gabapentin were recorded. To determine if included infants were more likely to receive analgesic and anxiolytic medications, a propensity score outcome model was developed accounting for variables that may affect likelihood of gabapentin receipt or outcome risk. Inverse probability weighted logistic regression and linear regression models were used to estimate the effect of gabapentin receipt on morphine dosage and the odds of midazolam receipt. Results: The cohort included 323 infants; 61% male, 91% with prior cardiac surgery or intervention. Gabapentin was prescribed in 74 (23%), with a median (IQR) maximum dose of 10.7 mg/kg/day (5.5, 23.4), and was continued at discharge in 54 (73%). Infants prescribed gabapentin were younger at time of SCPC (median 137 days old vs 146 days, p=0.007), had longer postoperative intensive care (median 5.8 days vs 3.1 days, p<0.001), and hospital length of stay (median 11.5 days vs 7 days, p<0.001). Those who underwent SCPC from 2015-19 had increased odds of gabapentin receipt compared to 2011-14 (OR 5.3, 95% CI 2.8, 10.0). All patients received morphine postoperatively while 136 (42%) received midazolam equivalents. Infants prescribed gabapentin received 1 mg/kg more of morphine equivalents (p=0.05) and were twice as likely to be prescribed a midazolam equivalent (OR 2.2, CI 1.2, 4.1, p=0.01). Conclusions: Gabapentin was used with increasing frequency over the duration of the study period. Patients prescribed gabapentin tended to be younger and have longer hospital stays, but did not appear to be spared exposure to opioid or benzodiazepine medications.

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