Perioperative gabapentin and pregabalin in cardiac surgery: a systematic review and meta-analysis

Maitra, Souvik; Baidya, Dalim Kumar; Bhattacharjee, Sulagna; Som, Anirban

doi:10.1016/j.bjane.2016.07.014

Cited by 16 publications

(13 citation statements)

References 37 publications

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“…22,23 Previous systematic reviews have weaknesses. First, most were designed to look at specific surgical populations [24][25][26][27][28][29][30][31][32][33] with often a limited sampling frame or a specific type of drugs [34][35][36][37][38][39][40] when pregabalin and gabapentin share the same mechanism of action and comparable pharmacologic properties. 41,42 Second, the concept of minimally important difference 43 for pain intensity was never considered in previous work, neither was the statistical reliability of the findings quantified.…”

Section: Perioperative Medicinementioning

confidence: 99%

Perioperative Use of Gabapentinoids for the Management of Postoperative Acute Pain

Verret¹,

Lauzier²,

Zarychanski³

et al. 2020

Anesthesiology

289

193

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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. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Section: Perioperative Medicinementioning

confidence: 99%

Perioperative Use of Gabapentinoids for the Management of Postoperative Acute Pain

Verret¹,

Lauzier²,

Zarychanski³

et al. 2020

Anesthesiology

289

193

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“…The selected interventions introduced in this study are borne from existing literature that supports their use as measures to hasten recovery from anesthesia, optimize multimodal analgesia, and limit the harmful impact of mechanical ventilation. They include preventative multimodal acetaminophen, gabapentin, intraoperative ketamine infusions, and regional analgesia, which have been shown to reduce perioperative opioid administration in cardiac and other types of surgery, [20][21][22][23][24][25][26] and therefore may reduce the impact of the anesthetic on rates of recovery. We incorporated a lung protective mechanical ventilation strategy, evidenced to reduce rates of postoperative lung injury and pneumonia.…”

Section: Discussionmentioning

confidence: 99%

Results from an enhanced recovery program for cardiac surgery

Grant

Isada

Ibekwe³

et al. 2020

The Journal of Thoracic and Cardiovascular Surgery

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“…57,58 A recently published systematic review of 281 studies (all surgical procedures) investigating the role of gabapentinoids for acute postoperative pain showed minimal analgesic benefit and increased incidence of visual disturbances and dizziness. 59 Another systematic review of the above studies by Maitra et al 60 found that gabapentin did not reduce postoperative opioid consumption after cardiac surgery. However, it might have reduced pain scores at the expense of increased duration of mechanical ventilation.…”

Section: Gabapentinmentioning

confidence: 99%

Nonopioid Analgesics in Postoperative Pain Management After Cardiac Surgery

Nazarnia

Subramaniam

2021

Semin Cardiothorac Vasc Anesth

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Opioid analgesia is still considered the standard of practice for cardiac surgery. In recent years, combinations of several nonnarcotic analgesics and regional analgesia have shown promise in restricting opioid use during and after cardiac surgery. Ketamine infusion, dexmedetomidine infusion, acetaminophen, ketorolac, and gabapentin are useful adjuvants in cardiac anesthesia practice and have opioid-sparing properties. The beneficial effects of nonnarcotic multimodal analgesia on intraoperative stress response, recovery profile, postoperative pain, and persistent opioid use after cardiac surgery are yet to be established, and further randomized clinical trials are required.

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Perioperative gabapentin and pregabalin in cardiac surgery: a systematic review and meta-analysis

Cited by 16 publications

References 37 publications

Perioperative Use of Gabapentinoids for the Management of Postoperative Acute Pain

Perioperative Use of Gabapentinoids for the Management of Postoperative Acute Pain

Results from an enhanced recovery program for cardiac surgery

Nonopioid Analgesics in Postoperative Pain Management After Cardiac Surgery

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