Serotonin Syndrome Following Tramadol and Gabapentin Use After Spine Surgery.

BACKGROUND: Serotonin syndrome is a common disease entity and could result in death if missed. Incidence of SS is underestimated due to misdiagnosis of many cases, especially the ones with less severe presentation. Many medications have been depicted as the source of SS. We present a case of serotonin syndrome in a patient who received intravenous tramadol and oral gabapentin as pain management following spine surgery.

CASE PRESENTATION: A 66-year-old man was admitted to our outpatient clinic with walking difficulties for 2 months. He was neurologically intact. However, he had neurological claudication. He was on insulin, telmisartan-hydrochlorothiazide, amlodipine and albuterol before the surgery, these drugs were continued following the surgery. After he was diagnosed with lumbar spinal stenosis, he underwent total laminectomies of L3 and L4 and bilateral transpedicular screw placement from L1 to L5. He received tramadol 100 mg once daily intravenously and gapapentin 300 mg thrice daily orally following the spine surgery. He became confused, agressive and agitated during his stay in the hospital postoperatively. He became frustrated with even his children and wife. He started receiving haloperidol and quetiapine after psychiatry consultation. Since he worsened immediately after quetiapine and haloperidol, his medications were ceased step by step manner (first tramadol, second gabapentin). He became stable in a few hours and his symptoms improved since then.

CONCLUSIONS: Physicians treating spine patients should be alert about serotonin syndrome in patients using both tramadol and gabapentin.