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.
What We Already Know about This Topic:
Gabapentinoids such as gabapentin and pregabalin are often included in perioperative multimodal analgesia regimens in an attempt to reduce acute, subacute, and chronic pain after surgery
Current American Pain Society and European Society of Regional Anaesthesia and Pain Therapy guidelines offer conflicting recommendations for the use of gabapentinoids in the perioperative period
What This Article Tells Us That Is New:
In a meta-analysis of 281 randomized controlled trials comparing gabapentinoids with controls, no clinically meaningful difference in acute, subacute, or chronic pain was observed
Although the risk of postoperative nausea and vomiting was slightly lower, adverse events of dizziness and visual disturbance were greater with gabapentinoids use