• Michael Verret, François Lauzier, Ryan Zarychanski, Caroline Perron, Xavier Savard, Anne-Marie Pinard, Guillaume Leblanc, Marie-Joëlle Cossi, Xavier Neveu, Alexis F Turgeon, and Canadian Perioperative Anesthesia Clinical Trials (PACT) Group.
• From the Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, CHU de Québec - Université Laval Research Center, Québec City, Québec, Canada (M.V., F.L., C.P., X.S., A.-M.P., G.L., M.-J.C., X.N., A.F.T.) the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine (M.V., F.L., A.-M.P., G.L., A.F.T.) the Department of Medicine (F.L.) Faculty of Medicine, and the Interdisciplinary Research Centre for Rehabilitation and Social Integration (A.-M.P.), Université Laval, Québec City, Québec, Canada the Department of Internal Medicine, Section of Critical Care, University of Manitoba, Winnipeg, Manitoba, Canada (R.Z.) the Department of Haematology and Medical Oncology, Cancer Care Manitoba, Winnipeg, Manitoba, Canada (R.Z.).
• Anesthesiology. 2020 Aug 1; 133 (2): 265-279.

BackgroundWidely used for acute pain management, the clinical benefit from perioperative use of gabapentinoids is uncertain. The aim of this systematic review was to assess the analgesic effect and adverse events with the perioperative use of gabapentinoids in adult patients.MethodsRandomized controlled trials studying the use of gabapentinoids in adult patients undergoing surgery were included. The primary outcome was the intensity of postoperative acute pain. Secondary outcomes included the intensity of postoperative subacute pain, incidence of postoperative chronic pain, cumulative opioid use, persistent opioid use, lengths of stay, and adverse events. The clinical significance of the summary estimates was assessed based on established thresholds for minimally important differences.ResultsIn 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.ConclusionsNo 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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