School of Medicine and Health Sciences Poster Presentations

Title

Investigating the Use of Gabapentin to Manage Transient Peripheral Neuropathy in Children Treated with Chimeric 14.18 Antibody

Poster Number

153

Document Type

Poster

Status

Medical Student

Abstract Category

Clinical Specialties

Keywords

gabapentin, neuroblastoma, neuropathic pain, immunotherapy, pediatric oncology

Publication Date

Spring 2018

Abstract

Background: Chimeric 14.18 (ch 14.18) is a human-mouse chimeric monoclonal antibody against GD2 ganglioside which is used to treat high-risk neuroblastoma in children, leading to increased survival. However, ch 14.18 therapy causes transient neuropathic pain-like syndrome and allodynia. In children, this transient pain syndrome can be managed with IV opioids safely and effectively but may be associated with respiratory depression or pruritus. Gabapentin, an anti-epileptic drug used for neuropathic pain, may be effective in managing ch 14.18 induced transient neuropathic-like pain and in decreasing opioid use.

Objective: The objective of this study is to assess whether the addition of gabapentin to IV opioids improved analgesia and decreased opioid use in children undergoing ch 14.18 therapy for high-risk neuroblastoma.

Methods: Electronic medical records were retrospectively reviewed to identify patients with high-risk neuroblastoma undergoing ch 14.18 therapy at Children’s National from November 2009 to August 2017. All patients received opioids via nurse-controlled analgesia (NCA) or patient-controlled analgesia (PCA). Demographic data, gabapentin doses, opioid use, pain scores, and pain location were recorded from their first cycle and last cycle of ch14.18. 24 hours opioid consumption (mg/kg/d) and mean daily pain score for each patient were obtained. Daily opioid use was log transformed, and daily mean pain score was square root transformed for analysis.

Results: 29 patients were identified. 7 of 29 children received gabapentin in addition to opioid PCA while undergoing ch 14.18 therapy. During the first cycle of therapy, root transformed average pain score in patients without gabapentin was 1.12 vs.0.83 with gabapentin. These values decreased to 0.60 vs. 0.69 respectively during the last cycle. Log transformed daily opioid use were -0.83 mg/kg/d in those not receiving gabapentin vs. -0.55 in those receiving gabapentin during the first cycle, and -0.91 vs. -0.86 respectively during the last cycle.

Conclusions: There was an overall decrease in average daily pain scores and opioid use between the first and last cycle but was not statistically significant. The addition of gabapentin did not decrease pain scores or opioid use during the first or last cycle. Due to the small sample size and the retrospective nature of this study, these results warrant further exploration of analgesic adjuncts to improve analgesia and reduce opioid use in children with transient neuropathic pain syndrome.

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Investigating the Use of Gabapentin to Manage Transient Peripheral Neuropathy in Children Treated with Chimeric 14.18 Antibody

Background: Chimeric 14.18 (ch 14.18) is a human-mouse chimeric monoclonal antibody against GD2 ganglioside which is used to treat high-risk neuroblastoma in children, leading to increased survival. However, ch 14.18 therapy causes transient neuropathic pain-like syndrome and allodynia. In children, this transient pain syndrome can be managed with IV opioids safely and effectively but may be associated with respiratory depression or pruritus. Gabapentin, an anti-epileptic drug used for neuropathic pain, may be effective in managing ch 14.18 induced transient neuropathic-like pain and in decreasing opioid use.

Objective: The objective of this study is to assess whether the addition of gabapentin to IV opioids improved analgesia and decreased opioid use in children undergoing ch 14.18 therapy for high-risk neuroblastoma.

Methods: Electronic medical records were retrospectively reviewed to identify patients with high-risk neuroblastoma undergoing ch 14.18 therapy at Children’s National from November 2009 to August 2017. All patients received opioids via nurse-controlled analgesia (NCA) or patient-controlled analgesia (PCA). Demographic data, gabapentin doses, opioid use, pain scores, and pain location were recorded from their first cycle and last cycle of ch14.18. 24 hours opioid consumption (mg/kg/d) and mean daily pain score for each patient were obtained. Daily opioid use was log transformed, and daily mean pain score was square root transformed for analysis.

Results: 29 patients were identified. 7 of 29 children received gabapentin in addition to opioid PCA while undergoing ch 14.18 therapy. During the first cycle of therapy, root transformed average pain score in patients without gabapentin was 1.12 vs.0.83 with gabapentin. These values decreased to 0.60 vs. 0.69 respectively during the last cycle. Log transformed daily opioid use were -0.83 mg/kg/d in those not receiving gabapentin vs. -0.55 in those receiving gabapentin during the first cycle, and -0.91 vs. -0.86 respectively during the last cycle.

Conclusions: There was an overall decrease in average daily pain scores and opioid use between the first and last cycle but was not statistically significant. The addition of gabapentin did not decrease pain scores or opioid use during the first or last cycle. Due to the small sample size and the retrospective nature of this study, these results warrant further exploration of analgesic adjuncts to improve analgesia and reduce opioid use in children with transient neuropathic pain syndrome.