Can Gabapentin Induce Compartment Syndrome?

Gabapentin is commonly prescribed for neuropathy and chronic pain, and its side effects are mostly benign. A poster presented at the American College of Foot and Ankle Surgeons Scientific Conference is a case study of a patient who experienced compartment syndrome induced by gabapentin.¹
 
The patient is a 32-year-old man who presented with swelling in the right leg of a sudden onset, as well as pain and motor and sensory dysfunction and muscle weakness. Symptoms had lasted 4 days and had progressed rapidly in the previous 24 hours. The patient denied previous trauma but noted decreased urination with dark urine.
 
Physicians discovered the patient had pain out of proportion with palpation and ankle dorsiflexion and plantarflexion, as well as an inability to range ankle and digits. The poster notes all 4 compartments in the right lower extremity were form and tense with significant pallor and worsening paresthesias compared to the left leg.
 
The patient had decompression of all 4 compartments, after which he had Doppler signals to all 3 major arteries and re-establishment of clinical reperfusion.
 
Reference
 
1. Atuluru V, Mansoori A, Carroll PJ. A case of gabapentin-induced compartment syndrome of the lower extremity. Presented at the American College of Foot and Ankle Surgeons Scientific Conference, Los Angeles, Feb. 9–12, 2023.