Newly Published
Perioperative Medicine  |   June 2020
Perioperative Use of Gabapentinoids for the Management of Postoperative Acute Pain: A Systematic Review and Meta-analysis
Author Notes
  • From the Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, CHU de Québec - Université Laval Research Center, Québec City, Québec, Canada (M.V., F.L., C.P., X.S., A.-M.P., G.L., M.-J.C., X.N., A.F.T.); the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine (M.V., F.L., A.-M.P., G.L., A.F.T.), the Department of Medicine (F.L.), Faculty of Medicine, and the Interdisciplinary Research Centre for Rehabilitation and Social Integration (A.-M.P.), Université Laval, Québec City, Québec, Canada; the Department of Internal Medicine, Section of Critical Care, University of Manitoba, Winnipeg, Manitoba, Canada (R.Z.); and the Department of Haematology and Medical Oncology, Cancer Care Manitoba, Winnipeg, Manitoba, Canada (R.Z.).
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • *Members of the Canadian Perioperative Anesthesia Clinical Trials (PACT) Group are listed in the appendix.
    Members of the Canadian Perioperative Anesthesia Clinical Trials (PACT) Group are listed in the appendix.×
  • Submitted for publication September 10, 2019. Accepted for publication May 20, 2020.
    Submitted for publication September 10, 2019. Accepted for publication May 20, 2020.×
  • Correspondence: Address correspondence to Dr. Turgeon: CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, 1401, 18e rue, Québec City, Québec G1J 1Z4, Canada. alexis.turgeon@fmed.ulaval.ca. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Central and Peripheral Nervous Systems / Pain Medicine / Opioid
Perioperative Medicine   |   June 2020
Perioperative Use of Gabapentinoids for the Management of Postoperative Acute Pain: A Systematic Review and Meta-analysis
Anesthesiology Newly Published on June 26, 2020. doi:https://doi.org/10.1097/ALN.0000000000003428
Anesthesiology Newly Published on June 26, 2020. doi:https://doi.org/10.1097/ALN.0000000000003428
Abstract

Background: Widely used for acute pain management, the clinical benefit from perioperative use of gabapentinoids is uncertain. The aim of this systematic review was to assess the analgesic effect and adverse events with the perioperative use of gabapentinoids in adult patients.

Methods: Randomized controlled trials studying the use of gabapentinoids in adult patients undergoing surgery were included. The primary outcome was the intensity of postoperative acute pain. Secondary outcomes included the intensity of postoperative subacute pain, incidence of postoperative chronic pain, cumulative opioid use, persistent opioid use, lengths of stay, and adverse events. The clinical significance of the summary estimates was assessed based on established thresholds for minimally important differences.

Results: In total, 281 trials (N = 24,682 participants) were included in this meta-analysis. Compared with controls, gabapentinoids were associated with a lower postoperative pain intensity (100-point scale) at 6 h (mean difference, −10; 95% CI, −12 to −9), 12 h (mean difference, −9; 95% CI, −10 to −7), 24 h (mean difference, −7; 95% CI, −8 to −6), and 48 h (mean difference, −3; 95% CI, −5 to −1). This effect was not clinically significant ranging below the minimally important difference (10 points out of 100) for each time point. These results were consistent regardless of the type of drug (gabapentin or pregabalin). No effect was observed on pain intensity at 72 h, subacute and chronic pain. The use of gabapentinoids was associated with a lower risk of postoperative nausea and vomiting but with more dizziness and visual disturbance.

Conclusions: No clinically significant analgesic effect for the perioperative use of gabapentinoids was observed. There was also no effect on the prevention of postoperative chronic pain and a greater risk of adverse events. These results do not support the routine use of pregabalin or gabapentin for the management of postoperative pain in adult patients.

Editor’s Perspective:

What We Already Know about This Topic:

  • Gabapentinoids such as gabapentin and pregabalin are often included in perioperative multimodal analgesia regimens in an attempt to reduce acute, subacute, and chronic pain after surgery

  • Current American Pain Society and European Society of Regional Anaesthesia and Pain Therapy guidelines offer conflicting recommendations for the use of gabapentinoids in the perioperative period

What This Article Tells Us That Is New:

  • In a meta-analysis of 281 randomized controlled trials comparing gabapentinoids with controls, no clinically meaningful difference in acute, subacute, or chronic pain was observed

  • Although the risk of postoperative nausea and vomiting was slightly lower, adverse events of dizziness and visual disturbance were greater with gabapentinoids use