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Yu L, Ran B, Li M, Shi Z. Gabapentin and pregabalin in the management of postoperative pain after lumbar spinal surgery: a systematic review and meta-analysis. Spine. 2013;38(22):1947–52. doi: 10.1097/BRS.0b013e3182a69b90. Perioperative gabapentin upped the risk of delirium, new antipsychotic use, and pneumonia in older adults after major surgery, a retrospective study showed. Gabapentin is a novel drug used for the treatment of postoperative pain with antihyperalgesic properties and a unique mechanism of action, which differentiates it from other commonly used drugs. Various studies have shown that perioperative use of gabapentin reduces postoperative pain. Multimodal analgesia has been an increasingly adopted strategy in the Enhanced Recovery After Surgery pathway, 1 which aims to reduce opioid use by using nonopioid analgesia, such as regional or epidural analgesia, nonsteroidal anti-inflammatory drugs, acetaminophen, and gabapentinoids. 2 Randomized clinical trials (RCTs) have demonstrated that In response to the opioid crisis, surgeons nationwide have sought to decrease opioid use by adopting opioid-sparing multimodal medication regimens to treat perioperative pain. 1 For example, gabapentinoids (gabapentin and pregabalin) are now commonly administered during the perioperative period as part of “enhanced recovery after surgery We recommend being selective with regard to using gabapentinoids for acute postoperative pain management after careful consideration of the potential side effect profile based on patient comorbidities as well as the expected severity of postoperative pain. Perioperative gabapentin, 1200 mg, administered preoperatively plus 600 mg every 8 hours continued for 72 hours after surgery did not affect time to pain cessation, the rate of pain resolution, or the proportion of patients with chronic pain at 6 months or 1 year following surgery. undergoing elective or emergent surgery under any type of anesthesia were considered. Included trials had to evaluate gabapentinoids (pregabalin or gabapentin) initiated between 1 week before and 12h after surgery. At least one outcome measure had to be assessed to be considered for inclusion. This review evaluated the efficacy and tolerability of peri-operative gabapentin administration to control acute post-operative pain. Peri-operative gabapentin administration was found to be effective in reducing pain scores, opioid requirements and opioid-related adverse effects in the first 24 hours after surgery. Given the significant differences between the studies and the possibility of We defined new postoperative gabapentin as fills for 7 days before surgery until 7 days after discharge. We excluded patients whose discharge disposition was hospice or death. The primary outcome was prolonged use of gabapentin, defined as a fill>90 days after discharge. Gabapentin is commonly indicated in the treatment of seizures. 27 Gabapentin, which acts on the nociceptive processes involved in central sensitization, has been shown to reduce hypersensitivity associated with nerve injury (hyperalgesia) and postoperative pain and inflammation in animal models. 28 Interestingly, gabapentin’s antiemetic In three different studies patients were given 300mg of gabapentin or placebo, 2 hours prior to surgery. 20–22 Bang et. al. reported that following arthroscopic rotator cuff surgery, VAS scores taken at 2, 6, and 12 hours post-operatively were significantly lower in patients that received gabapentin compared to placebo. 20 After open High dose gabapentin taper may be considered for patients with concomitant post-operative pain and alcohol withdrawal to decrease benzodiazepine use (see Alcohol Withdrawal Guideline) In three different studies patients were given 300mg of gabapentin or placebo, 2 hours prior to surgery. 20–22 Bang et. al. reported that following arthroscopic rotator cuff surgery, VAS scores taken at 2, 6, and 12 hours post-operatively were significantly lower in patients that received gabapentin compared to placebo. 20 After open Similarly, aside from 24 h after surgery, gabapentin significantly reduced pain with movement (25–27,31,34,35,37,38) by 18% to 28% (VAS 8.2 mm to 10.2 mm) after surgery . The pooled effects on VAS pain scores displayed significant heterogeneity, which was not explained by subgroup analyses based on surgical procedure, gabapentin dose or study Gabapentin appears safe and well tolerated when used for persistent post-operative and post-traumatic pain in thoracic surgery patients, although minor side effects do occur. Gabapentin may relieve refractory chest wall pain in some of these patients, particularly those with more severe pain. Their findings, recently published in the journal Anesthesiology, indicate that the analgesic benefits of pregabalin and gabapentin after surgery are negligible, regardless of the dose or type of operation. Gabapentinoids were also ineffective in preventing chronic pain from developing after surgery, one of the primary justifications for using In summary, the administration of gabapentin was effective in decreasing postoperative narcotic consumption and the incidence of pruritus. There was a high risk of selection bias and a higher heterogeneity of knee flexion range in this analysis. Increasing numbers of randomized trials indicate that gabapentin is effective as a postoperative analgesic. This procedure-specific systematic review aims to analyse the 24-hour postoperative effect of gabapentin on acute pain in adults.
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