Daily intake of 900 mg gabapentin before spine surgery associated with low pain intensity: JAMA

A new study published in the Journal of American Medical Association suggests that among all doses, gabapentin 900 mg per day prior to spine surgery is related with the least Visual Analog Scale (VAS) pain score.

Gabapentinoids, like gabapentin, have the ability to prevent central nerve sensitization. Although the methods of action and chemical structures of these two medications are identical, pregabalin is more powerful and takes effect faster than gabapentin. The appropriate dosage of pregabalin plus gabapentin for pain management and safety in the individuals with spine surgery is unknown. As a result, Sung Huang Laurent Tsai and colleagues undertook this study to assess the relationships of pain, opioid intake, and adverse events with different pregabalin and gabapentin doses in patients having spine surgery.

Articles were found in the databases PubMed/MEDLINE, Web of Science, Embase, Cochrane Library, and Scopus till August 7, 2021. Patients who got pregabalin or gabapentin while receiving spine surgery were included in randomized clinical studies. Two scientists extracted data independently using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) reporting guidelines. The network meta-analysis was carried out using a random-effects model from August 2022 to February 2023. 

The key findings of this study were:

The systematic review and network meta-analysis comprised 27 randomized clinical trials involving 1861 people.

Gabapentin 900 mg per day had the lowest VAS pain score when compared to placebo, followed by gabapentin 1200 mg/day, gabapentin 600 mg/day, gabapentin 300 mg/day, pregabalin 300 mg/day, pregabalin 150 mg/day, and pregabalin 75 mg/day.

Furthermore, gabapentin 900 mg per day was related with the least opioid consumption across all gabapentin and pregabalin doses, with a mean difference of 22.07% for the surface below the cumulative ranking curve compared to placebo.

In terms of adverse effects, there was not a statistically significant distinction between any regimens.

In conclusion, the outcomes of this study show that preoperative gabapentin and pregabalin treatment may effectively decrease postoperative pain and minimize opioid use in patients having spine surgery. 

Reference:

Tsai, S. H. L., Hu, C.-W., El Sammak, S., Durrani, S., Ghaith, A. K., Lin, C. C. J., Krzyż, E. Z., Bydon, M., Fu, T. S., & Lin, T. Y. (2023). Different Gabapentin and Pregabalin Dosages for Perioperative Pain Control in Patients Undergoing Spine Surgery. In JAMA Network Open (Vol. 6, Issue 8, p. e2328121). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2023.28121