Gabapentinoids have no analgesic effect on postoperative acute pain

It was a systemic review and meta-analysis of 281 clinical trials with 24,682 adult patients who underwent elective or emergent surgery. The major outcome assessed was the intensity of postoperative acute pain. Researchers also assessed the intensity of postoperative subacute pain, incidence of postoperative chronic pain, cumulative opioid use, persistent opioid use, lengths of stay, and adverse events as a secondary outcome.

Key findings of the study were:

• The researchers observed that gabapentinoids were associated with a lower postoperative pain intensity when compared with placebo at 6th,12th, 24th and 48th hour. However, they found the differences were not statistically significant ranging below the minimally important difference (10 points out of 100) for each time point.

• They found no difference in pain intensity between pregabalin and gabapentin.

• They also found that Gabapentinoids were not associated with the incidence of postoperative chronic pain.

• They noted Gabapentinoids slightly lower use of opioids at 24 hours (mean difference, −7.90 mg) and increases the length of hospital stay (mean difference, 2.96 hours).

• They reported less incidence of nausea/vomiting in Gabapentinoids group. However, they noted a significantly more visual disturbance (RR, 1.89) and dizziness (RR, 1.25)

The authors concluded, "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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DOI: https://doi.org/10.1097/ALN.0000000000003428