Pregabalin or gabapentin have no clinically meaningful advantages in the management of postoperative pain in adult patients, according to study results published in Anesthesiology.
There are inconsistent recommendations regarding the use of gabapentinoids, including pregabalin and gabapentin, for the management of postoperative pain. Furthermore, experts have raised concerns regarding the safety and clinical benefit of this class of drugs.
In this systematic review and meta-analysis of randomized controlled trials, Verret and colleagues explore the analgesic effect and adverse events of perioperative use of gabapentinoids in adults. The primary outcome was the intensity of postoperative pain.
In total, 281 trials (n= 24,682 participants) were included in the meta-analysis. Most studies were performed in patients undergoing orthopedic or spinal surgeries (73 trials, 27%) or in patients undergoing abdominal surgeries (64 trials, 23%). In 198 trials (71%), gabapentinoids were administered before surgery, the medications were given after surgery in 12 trials (4%), and at both times in 71 trials (25%).
The meta-analysis revealed the postoperative pain intensity was slightly lower at 6 hours (6h) (man difference, -10; 95% CI, -12 to -9), 12h (mean difference, -9; 95% CI, -10 to -7), 24h (mean difference, -7; 95% CI, -8 to -6) and 48h (mean difference, -3; 95% CI, -5 to -1) with gabapentinoids compared with controls, but not at 72h. At each time point, the analgesic effect was not clinically significant as it did not reach the minimally clinically significant difference (10 of 100). The effect was not different with the type of drugs (gabapentin or pregabalin).
Nausea and vomiting were less frequent with perioperative use of gabapentinoids (risk ratio, 0.77; 95% CI, 0.72-0.82), while visual disturbance (risk ratio, 1.89; 95% CI, 1.52-2.33) and dizziness (risk ratio, 1.25; 95% CI, 1.13-1.39) were more common.
The study had several limitations, including the risk for bias of the included trials, unexplained residual statistical heterogeneity, and large number of relatively small trials.
The researchers concluded that “these results do not support the routine use of gabapentin or pregabalin for the management of postoperative pain in adult patients. Additional trials evaluating the effect of the perioperative use of gabapentinoids on postoperative acute pain intensity are also not required.”
Verret M, Lauzier F, Zarychanski R, et al. Perioperative use of gabapentinoids for the management of postoperative acute pain: a systematic review and meta-analysis. Anesthesiology. 2020;133(2):265-279.