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Verret M, Lauzier F, Zarychanski R, et al. Perioperative Use of Gabapentinoids for the Management of Postoperative Acute Pain. Anesthesiology. 2020 Aug 1;133(2):265-279. doi: 10.1097/ALN.0000000000003428. (Systematic review)
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.

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Comments from MORE raters

Physician rater

The potential benefit in adding gabapentin in multi-modal analgesia for postoperative pain management has been a matter of discussions since long. The present meta-analysis show that there is most limited if any evidence for a beneficial effects from its use perioperatively for acute pain.

Physician rater

This states what most surgeons using local anesthesia already know. The gabenoids such as gabapentin work on chronic neuropathic pain by stabilizing the nerve membrane and preventing neuropathy. There is no good basic science explanation and no clinical evidence for these compounds producing acute pain relieve when mixed with local anesthetics.

Physician rater

Technically, this is a well done systematic review of the literature. However, the meta-analysis looks like it missed a forest plot cumulative diagram that could make the exploitation of the results more suitable for the reader. Regarding the conclusions, I am not surprised it was somehow similar to what we have seen with peridural analgesia few years back. There is no objective and significant better pain control but more side effects.
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