A meta-analysis of the preoperative use of gabapentinoids for the treatment of acute postoperative pain following spinal surgery

Bo Liu, Ruihe Liu, Lifeng Wang, Bo Liu, Ruihe Liu, Lifeng Wang

Abstract

Background: Gabapentinoid drugs, which include gabapentin and pregabalin, play an established role in the management of neuropathic pain. However, whether preoperative administration of gabapentinoids has a beneficial role in controlling acute pain after spinal surgery is unknown. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to determine the efficacy and safety of the preoperative use of gabapentinoids (gabapentin and pregabalin) for the treatment of acute postoperative pain following spinal surgery.

Methods: In March 2017, a systematic computer-based search was conducted in PubMed, EMBASE, Web of Science, Cochrane Library, and Google databases. RCTs comparing gabapentinoids (gabapentin and pregabalin) with placebo in patients undergoing spine surgery were retrieved. The primary endpoint was the visual analogue scale (VAS) score with rest or mobilization at 6, 12, 24, and 48 hours and cumulative morphine consumption at 24 and 48 hours. The secondary outcomes were complications of nausea, vomiting, sedation, dizziness, headache, urine retention, pruritus, and visual disturbances. After tests for publication bias and heterogeneity among studies were performed, data were aggregated for random-effects models when necessary.

Results: Sixteen clinical studies (gabapentin group n = 8 and pregabalin group n = 8) were ultimately included in the meta-analysis. Gabapentinoids were associated with reduced pain scores at 6, 12, 24, and 48 hours. Similarly, gabapentinoids were associated with a reduction in cumulative morphine consumption at 24 and 48 hours. Furthermore, gabapentinoids can significantly reduce the occurrence of nausea, vomiting, and pruritus. There were no significant differences in the occurrence of sedation, dizziness, headache, visual disturbances, somnolence, or urine retention.

Conclusions: Preoperative use of gabapentinoids was able to reduce postoperative pain, total morphine consumption, and morphine-related complications following spine surgery. Further studies should determine the optimal dose and whether pregabalin is superior to gabapentin in controlling acute pain after spine surgery.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
PRISMA flowchart for the included studies. PRISMA = preferred reporting items for systematic reviews and meta-analyses.
Figure 2
Figure 2
The risk of bias summary for the included studies.
Figure 3
Figure 3
The risk of bias graph for the included studies.
Figure 4
Figure 4
Forest plot comparing VAS at 6 h between the gabapentinoids group and the control group. VAS = visual analogue scale.
Figure 5
Figure 5
Forest plot comparing VAS at 12 h between the gabapentinoids group and the control group. VAS = visual analogue scale.
Figure 6
Figure 6
Forest plot comparing VAS at 24 h between the gabapentinoids group and the control group. VAS = visual analogue scale.
Figure 7
Figure 7
Funnel plot comparing VAS at 6 h between the gabapentinoids group and the control group. VAS = visual analogue scale.
Figure 8
Figure 8
Begg test comparing VAS at 6 h between the gabapentinoids group and the control group. VAS = visual analogue scale.
Figure 9
Figure 9
Forest plot comparing cumulative morphine consumption at 24 h between the gabapentinoids group and he control group.
Figure 10
Figure 10
Forest plot comparing cumulative morphine consumption at 48 h between the gabapentinoids group and the control group.

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Source: PubMed

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