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. 2016 Sep 12:9:631-40.
doi: 10.2147/JPR.S112626. eCollection 2016.

Use of preoperative gabapentin significantly reduces postoperative opioid consumption: a meta-analysis

Sudha Arumugam  1 , Christine Sm Lau  2 , Ronald S Chamberlain  3
Affiliations

Use of preoperative gabapentin significantly reduces postoperative opioid consumption: a meta-analysis

Sudha Arumugam et al. J Pain Res. .

Abstract

Objectives: Effective postoperative pain management is crucial in the care of surgical patients. Opioids, which are commonly used in managing postoperative pain, have a potential for tolerance and addiction, along with sedating side effects. Gabapentin's use as a multimodal analgesic regimen to treat neuropathic pain has been documented as having favorable side effects. This meta-analysis examined the use of preoperative gabapentin and its impact on postoperative opioid consumption.

Materials and methods: A comprehensive literature search was conducted to identify randomized control trials that evaluated preoperative gabapentin on postoperative opioid consumption. The outcomes of interest were cumulative opioid consumption following the surgery and the incidence of vomiting, somnolence, and nausea.

Results: A total of 1,793 patients involved in 17 randomized control trials formed the final analysis for this study. Postoperative opioid consumption was reduced when using gabapentin within the initial 24 hours following surgery (standard mean difference -1.35, 95% confidence interval [CI]: -1.96 to -0.73; P<0.001). There was a significant reduction in morphine, fentanyl, and tramadol consumption (P<0.05). While a significant increase in postoperative somnolence incidence was observed (relative risk 1.30, 95% CI: 1.10-1.54, P<0.05), there were no significant effects on postoperative vomiting and nausea.

Conclusion: The administration of preoperative gabapentin reduced the consumption of opioids during the initial 24 hours following surgery. The reduction in postoperative opioids with preoperative gabapentin increased postoperative somnolence, but no significant differences were observed in nausea and vomiting incidences. The results from this study demonstrate that gabapentin is more beneficial in mastectomy and spinal, abdominal, and thyroid surgeries. Gabapentin is an effective analgesic adjunct, and clinicians should consider its use in multimodal treatment plans among patients undergoing elective surgery.

Keywords: gabapentin; opioid; postoperative pain; preemptive analgesia.

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Figures

Figure 1
Figure 1
A CONSORT diagram detailing the study selection process.
Figure 2
Figure 2
A forest plot evaluating the standardized difference in mean in postoperative opioid consumption with the use of gabapentin compared to control. Abbreviations: Std diff, standard difference; CI, confidence interval.
Figure 3
Figure 3
A forest plot evaluating the SMD in postoperative opioid consumption with the use of gabapentin compared to control: a subgroup analysis by type of opioid. Abbreviations: SMD, standard mean difference; Std diff, standard difference; CI, confidence interval.
Figure 4
Figure 4
A forest plot evaluating the SMD in postoperative opioid consumption with the use of gabapentin compared to control: a subgroup analysis by type of surgery. Abbreviations: SMD, standard mean difference; Std diff, standard difference; CI, confidence interval.
Figure 5
Figure 5
A forest plot evaluating the SMD in postoperative opioid consumption with the use of gabapentin compared to control: a subgroup analysis by dose. Abbreviations: SMD, standard mean difference; Std diff, standard difference; CI, confidence interval.
Figure 6
Figure 6
A forest plot evaluating the RR of the incidence of nausea with the use of gabapentin compared to control. Abbreviations: RR, relative risk; CI, confidence interval.
Figure 7
Figure 7
A forest plot evaluating the RR of the incidence of vomiting with the use of gabapentin compared to control. Abbreviations: RR, relative risk; CI, confidence interval.
Figure 8
Figure 8
A forest plot evaluating the RR of the incidence of somnolence with the use of gabapentin compared to control. Abbreviations: RR, relative risk; CI, confidence interval.
Figure 9
Figure 9
A funnel plot assessing publication bias (analyzing the effect of preoperative gabapentin administration on opioid consumption within the first 24 hours postoperatively). Abbreviation: Std diff, standard difference.
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