Hu J, Huang D, Li M, et al. Effects of a single dose of preoperative pregabalin and gabapentin for acute postoperative pain: a network meta-analysis of randomized controlled trials. J Pain Res. 2018 Nov 2;11:2633-2643. doi: 10.2147/JPR.S170810. eCollection 2018. (Systematic review)

Background: Pregabalin (PGB) and gabapentin (GBP) are current and emerging drugs in the field of pre-emptive preoperative analgesia. However, the role of PGB or GBP in acute postoperative pain management still remains elusive.

Materials and methods: We conducted a comprehensive literature search of articles published by December 3, 2017. A total of 79 randomized controlled trials with 6,201 patients receiving single-dose premedication were included. Through a network meta-analysis (NMA), we validated the analgesic effect and incidence of adverse events by using various doses of PGB or GBP administration.

Results: NMA results suggested that the analgesic effect may be dose related. For 24-hour opioid consumption, a consistent decrease was found with the increase in the dose of PGB or GBP. For 24-hour pain score at rest, a high dose (=150 mg) of PGB was more effective in decreasing pain score than a dose of 75 mg, and a high dose (=900 mg) of GBP reduced pain intensity than doses of 300 or 600 mg. Moreover, the incidence of adverse reactions varied with varying doses of PGB or GBP.

Conclusion: A dose-response relationship was detected in opioid consumption and postoperative pain for a single-dose preoperative administration of PGB and GBP. Making reasonable choice of drugs and dosage may prevent the occurrence of adverse reactions.

Discipline Area Score
Physician 6 / 7
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Comments from MORE raters

Physician rater

SR with several small studies that have a high risk of bias. No attempt was made to account for heterogeneity of the results and there were several interventions that we're evaluated. Not really sure whether they should have been pooled. As usually happens with pain studies, comparing to placebo is practically worthless, especially in this type of design.

Physician rater

The network meta-analysis (NWM) was conducted with Cochrane methodology and covers all the necessary methodologic standards. The results of this publication should make individual anaesthetic practitioners think about the need to use these interventions in their patient population. The suggestion that there is a dose-response relation for the beneficial effects as well as side effects is very useful information. However, the effect of nausea and vomiting is possibly a red herring; it could very well be due to possible hypotension caused by the treatment itself (unfortunately changes in blood pressure are not identified in the analysis; however, the increased dizziness reported might be due reduced blood pressure). Overall, this NWM is a very useful addition to our knowledge of perioperative management of patients.
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