Perioperative Use of Gabapentinoids for the Management of Postoperative Acute Pain: A Systematic Review and Meta-analysis.
Journal
Anesthesiology
ISSN: 1528-1175
Titre abrégé: Anesthesiology
Pays: United States
ID NLM: 1300217
Informations de publication
Date de publication:
08 2020
08 2020
Historique:
entrez:
16
7
2020
pubmed:
16
7
2020
medline:
17
9
2020
Statut:
ppublish
Résumé
Widely 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. Randomized 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. 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. 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.
Sections du résumé
BACKGROUND
Widely 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.
METHODS
Randomized 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.
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.
Identifiants
pubmed: 32667154
doi: 10.1097/ALN.0000000000003428
pii: 00000542-202008000-00011
doi:
Substances chimiques
Analgesics
0
Pregabalin
55JG375S6M
Gabapentin
6CW7F3G59X
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Comment
Langues
eng
Sous-ensembles de citation
IM
Pagination
265-279Subventions
Organisme : CIHR
ID : 354039
Pays : Canada
Investigateurs
Al McAuley
(A)
Alana Flexman
(A)
André Y Denault
(AY)
Angela Jerath
(A)
Christopher Prabhakar
(C)
Colin McCartney
(C)
Corey Sawchuk
(C)
Cynthia Yarnold
(C)
David Boyle
(D)
David Mazer
(D)
David Roach
(D)
Diem Tran
(D)
Dolores McKeen
(D)
Doreen Yee
(D)
Duminda Wijeysundera
(D)
Emilie Belley-Côté
(E)
Eric Jacobsohn
(E)
Étienne de Médicis
(É)
Francois M Carrier
(FM)
Greg Hare
(G)
Gregory Bryson
(G)
Hilary Grocott
(H)
Homer Yang
(H)
Jason McVicar
(J)
Jennifer O'Brien
(J)
Jessica Spence
(J)
Jim Kim
(J)
John Murkin
(J)
Jonathan Gamble
(J)
Kathryn Sparrow
(K)
Kim Wong
(K)
Stuart McCluskey
(S)
Michael Bautista
(M)
Michael Law
(M)
Michael Schmidt
(M)
Vishal Uppal
(V)
Thomas Mutter
(T)
Tarit Saha
(T)
Surita Sidhu
(S)
Summer Syed
(S)
Stephen Kowalski
(S)
Scott Brudney
(S)
Rosaleen Chun
(R)
Ronald George
(R)
Ron Ree
(R)
Richard Hall
(R)
Richa Dhawan
(R)
Ramiro Arellano
(R)
Rakesh Sondekoppam
(R)
Pierre Beaulieu
(P)
Philippe Richebe
(P)
Peter Choi
(P)
Nicola Edwards
(N)
Commentaires et corrections
Type : CommentOn
Type : ErratumIn
Type : CommentIn
Type : CommentIn
Type : CommentIn