The efficacy of gabapentin in reducing pain intensity and morphine consumption after breast cancer surgery

Abstract

Background:The purpose of this meta-analysis from randomized controlled trials (RCTs) was to determine the efficacy and safety of the preoperative use of gabapentin for the treatment of acute and chronic postoperative pain following breast cancer surgery.Methods:In November 2017, a systematic computer-based search was conducted in PubMed, Embase, Web of Science, Cochrane Library, and Google databases. RCTs comparing gabapentin with placebo in patients undergoing breast cancer surgery were retrieved. The primary endpoint was the visual analog scale (VAS) after surgery and 24 hours after surgery and total morphine consumption. The secondary outcomes were incidence of chronic pain and complications (the incidence of nausea). Software Stata 12.0 was used for meta-analysis.Results:Finally, 9 RCTs were included in the meta-analysis. Results indicated that gabapentin was associated with reduced pain scores after surgery and 24 hours after surgery. Meanwhile, oral gabapentin was associated with a reduction of the total morphine consumption after breast cancer surgery. Similarly, gabapentin was associated with a reduction in the incidence of chronic pain and the incidence of nausea.Conclusions:Preoperative use of gabapentin was able to reduce acute and chronic postoperative pain, total morphine consumption and the occurrence of nausea following breast cancer surgery. Further studies should determine the optimal dose of gabapentin for pain control after breast cancer surgery.

PROSPECT guideline for oncological breast surgery: a systematic review and procedure‐specific postoperative pain management recommendations

“…Two meta‐analyses of parallel group, placebo‐controlled RCTs have evaluated the efficacy of the pre‐operative use of gabapentin for the treatment of acute and chronic postoperative pain following breast cancer surgery . The meta‐analysis by Rai et al.…”

“… included all the studies of the meta‐analysis by Jiang et al. but also included one study concerning gabapentin (516 patients) and four studies concerning pregabalin (209 patients). Doses of gabapentin ranged between 300 mg and 1200 mg. Doses of pregabalin ranged between 150 mg and 900 mg. Gabapentin reduced pain scores in the post‐anaesthetic care unit (PACU) and 24 h postoperatively .…”

Gabapentin Completely Neutralized the Acute Morphine Activation in the Rat Hypothalamus: a c-Fos Study

“…Recent clinical study documented that co administration of opioid and GBP provided reduction in opioid use and complications this study also noticed the clinical benefit including critical respiratory failure [66]. Recently, increasing number of clinical reports on efficacy of gabapentin (pre and post-operative) on 'morphine consumption' and in 'reducing pain intensity' have been documented [64][65][66][67][68]. Thus the present study strongly indicated to reveal the functional molecular singling circuits of 'combination of morphine and gabapentin' observed in clinical reports.…”

Narcotics and breast surgery: a review of current literature

“…Chronic neuropathic pain can be a common problem after surgery, especially in the breast cancer surgery population and those undergoing axillary lymph node dissections. A meta-analysis by Jiang et al [12] aimed to determine the effect of gabapentin on pain control after breast surgery. This review included nine randomized controlled trials that studied women undergoing breast cancer surgery who were randomized to placebo vs. gabapentin.…”

“…There was significant heterogeneity in pain score outcomes, which they partly contributed to patients undergoing axillary lymph node dissection and the likelihood of more chronic pain development after surgery, which gabapentin is thought to have less of an effect on treatment. They concluded that preoperative use of gabapentin was successful in reducing acute postoperative pain and chronic pain incidence, but encouraged future studies to understand its effect when used postoperatively [12] .…”