Possible gabapentin and ketamine interaction causing prolonged central nervous system depression during post-operative recovery following cervical laminoplasty: a case report

Abstract

Introduction: The drugs gabapentin and ketamine are used frequently in the peri-operative setting. There is poor documentation whether or not gabapentin and ketamine interact to cause prolonged depression of the central nervous system.

Case presentation: The following is a case report in which a patient, a 58-year-old African-American man, with a history of post-traumatic stress disorder and chronic pain underwent a cervical laminoplasty procedure. The patient presented post-operatively in a dissociative state with paralysis, anarthria and preservation of consciousness. All organic causes were excluded, with the exception of prolonged central nervous system depression from a gabapentin/ketamine drug interaction. A new onset conversion disorder could also not be excluded.

Conclusion: Although this case by itself is not enough evidence to substantiate a true adverse reaction between gabapentin and ketamine, it is enough to warrant further investigation.

Figure 1

Sagittal T2-weighted MRI showing narrowing of spinal canal at C3-C7.

Figure 2

Post-operative axial CT of head showing no intracranial pathology.

Figure 3

CT (sagittal view) of cervical region showing normal post-operative changes.

Figure 4

Normal post-operative sagittal T1-weighted MRI of patient's head.

Figure 5

Normal post-operative sagittal T1-weighted MRI of patient's neck.