Perioperative gabapentin and post cesarean pain control: A systematic review and meta-analysis of randomized controlled trials

Felder, Laura; Saccone, Gabriele; Scuotto, Sergio; Monks, David T.; Carvalho, Jose C. A.; Zullo, Fulvio; Berghella, Vincenzo

doi:10.1016/j.ejogrb.2018.11.026

Cited by 30 publications

(33 citation statements)

References 21 publications

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“…Possible explanations may be the difference of the surgical procedure and the limitation sample sizes. However, Felder's [28] meta-analysis shared the same conclusion that no significant differences were found in the use of additional pain medications, supplemental opioids between gabapentin group and placebo group. Subgroup analysis showed that a reduction in the incident rate of postoperative pruritus after TKA was related to gabapentin, but the effect was not found after THA.…”

Section: Discussionmentioning

confidence: 92%

The efficacy of perioperative gabapentin for the treatment of postoperative pain following total knee and hip arthroplasty: a meta-analysis

Kang

Zhao

et al. 2020

J Orthop Surg Res

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Background: Postoperative pain after total knee arthroplasty (TKA) and total hip arthroplasty (THA) influence patients' rehabilitation and life quality. Although gabapentin has been widely used for analgesia, its efficacy is still controversial in TKA and THA. This meta-analysis was performed to assess the efficacy and safety of gabapentin following TKA and THA. Method: Electronic databases including PubMed, EMBASE, Cochrane Central Register of Controlled Trials, MEDLINE, and ClinicalTrials.gov were comprehensively retrieved for randomized controlled trials from their inception to June 2019. A total of 7 studies, which compared the administration of gabapentin with that of placebo for the treatment of postoperative pain, were included in our meta-analysis. The meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Result: There was no difference in pain score at 24 (P = 0.87), 48 (P = 0.15), and 72 (P = 0.85) h associated with the use of gabapentin. Likewise, no difference in accumulative morphine consumption at 48 h following TKA or THA was found between gabapentin and placebo (DM = − 8.14, 95% CI − 18.55 to 2.28, P = 0.13). The incidence of opioid-related adverse effects, including nausea, pruritus, sedation, and dizziness, is no difference between gabapentin and placebo group. However, subgroup analysis indicated that gabapentin could reduce the incidence of pruritus after TKA (RR = 0.35, 95% CI 0.12 to 0.99, P = 0.05). Conclusion: Based on our meta-analysis, gabapentin did not decrease postoperative pain, cumulative morphine consumption, and the incidence of adverse effects after TKA and THA. There was not enough evidence to support the administrations of gabapentin for postoperative pain after TKA and THA.

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Section: Discussionmentioning

confidence: 92%

The efficacy of perioperative gabapentin for the treatment of postoperative pain following total knee and hip arthroplasty: a meta-analysis

Kang

Zhao

et al. 2020

J Orthop Surg Res

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“…The lack of a clear benefit with gabapentin use correlates with a recently reported double-blind randomized trial demonstrating that gabapentin did not reduce postoperative pain with first trimester surgical abortion [22]. When considering these findings together with the benefit of pre-emptive gabapentin for pain reduction with abdominal hysterectomy [8][9][10][11][12][13][14], and the slight and variable pain reduction benefit with cesarean delivery [15][16][17][18][19][20], perhaps gabapentin is more beneficial for incision-related (sensory) pain and less for uterine cramping related (visceral) pain.…”

Section: Discussionmentioning

confidence: 84%

“…The primary outcome was median change in NRS score from baseline to 8 hours post dilator insertion. We assessed median change in individual pain score from baseline, as opposed to median group scores at each time point, because using median change in individual pain score has been adopted in other fields as the preferred standard for evaluating pain management [20]. Secondary outcomes included pain score change at other time points, difference in pain scores by gestational age, study drug side effects, and analgesic use.…”

Section: Methodsmentioning

confidence: 99%

“…A systematic review demonstrated a significant benefit of pre-operative gabapentin for preemptive analgesia for abdominal hysterectomy [14]. Data regarding preoperative gabapentin use in other contexts, such as Cesarean delivery and laparoscopic ovarian cystectomy, are less consistent [15][16][17][18][19][20]. The heterogeneity of gabapentin dosing and overall pain regimen along with study design limitations make these data challenging to generalize to abortion procedures.…”

Section: Introductionmentioning

confidence: 99%

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Gabapentin for pain management after osmotic dilator insertion and prior to dilation and evacuation: A randomized controlled trial

Creinin

Schimmoeller²,

Matulich

et al. 2020

Contraception

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Objective: To evaluate if gabapentin 600 mg reduces pain after osmotic dilator placement the day before a dilation and evacuation (D&E) procedure. Study Design: We conducted a double-blind, placebo-controlled, randomized (stratified by vaginal parity) trial among women undergoing osmotic dilator placement before D&E at 15 to 23 5/7 weeks gestation. Subjects received gabapentin 600 mg or placebo 30 minutes before dilator placement, with re-dosing 8 hours later. We assessed pain after dilator placement using a numeric rating scale (NRS; scale 0-10) at 5 minutes, 2, 4, and 8 hours, and at presentation for D&E. The primary outcome was median NRS pain score change from baseline to 8 hours after dilator placement. Secondary outcomes included gabapentin-related side effects and analgesic use. Results: Of 121 randomized women, we excluded three subjects (allergic reaction [placebo], randomization error, no NRS data), leaving 60 gabapentin and 58 placebo subjects. Of 110 (93%) women who provided 8-hour data, median pain score changes from baseline did not differ between gabapentin and placebo groups overall (2 vs. 2.5, p=0.52), in vaginally nulliparous women (2 vs. 4, p=0.10) or in parous women (2 vs. 1.5, p=0.37). We found no statistically significant differences in median pain score change from baseline to any timepoint overall or when stratified by parity. Beginning at 2 hours after dilator placement, more gabapentin than placebo users experienced dizziness (29/53[55%] vs. 11/53[21%], p=0.001) and tiredness (34/54[63%] vs. 17/54[31%], p=0.002). The proportion of women using narcotics did not differ between gabapentin (35/60[58%]) or placebo (40/58[69%]) users (p=0.26). 3 Conclusions: Gabapentin does not reduce pain with overnight osmotic dilator placement prior to D&E and causes drug-related side effects.

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“…These RCTs have been included in 18 systematic reviews that aimed to assess the effectiveness of gabapentin versus placebo in the perioperative period; 11 of these in surgical populations. [15][16][17][18][19][20][21][22][23][24][25] All reviews reached the same conclusions; that gabapentin reduced opioid consumption and postoperative pain scores at 24 hours (p<0.001), but none has assessed the impact on quality of life. The most recent systematic review was published since this study started 25 and assessed the impact of gabapentin on length of hospital stay in eight trials which provided very low to moderate quality evidence and found no statistically significant difference in the length of hospital stay between the gabapentin and control group.…”

mentioning

confidence: 80%

Effectiveness, cost-effectiveness and safety of gabapentin versus placebo as an adjunct to multimodal pain regimens in surgical patients: protocol of a placebo controlled randomised controlled trial with blinding (GAP study)

et al. 2020

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IntroductionGabapentin is an antiepileptic drug currently licensed to treat epilepsy and neuropathic pain but has been used off-label to treat acute postoperative pain. The GAP study will compare the effectiveness, cost-effectiveness and safety of gabapentin as an adjunct to standard multimodal analgesia versus placebo for the management of pain after major surgery.Methods and analysisThe GAP study is a multicentre, double-blind, randomised controlled trial in patients aged 18 years and over, undergoing different types of major surgery (cardiac, thoracic or abdominal). Patients will be randomised in a 1:1 ratio to receive either gabapentin (600 mg just before surgery and 600 mg/day for 2 days after surgery) or placebo in addition to usual pain management for each type of surgery. Patients will be followed up daily until hospital discharge and then at 4 weeks and 4 months after surgery. The primary outcome is length of hospital stay following surgery. Secondary outcomes include pain, total opioid use, adverse health events, health related quality of life and costs.Ethics and disseminationThis study has been approved by the Research Ethics Committee . Findings will be shared with participating hospitals and disseminated to the academic community through peer-reviewed publications and presentation at national and international meetings. Patients will be informed of the results through patient organisations and participant newsletters.Trial registration numberISRCTN63614165.

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Perioperative gabapentin and post cesarean pain control: A systematic review and meta-analysis of randomized controlled trials

Cited by 30 publications

References 21 publications

The efficacy of perioperative gabapentin for the treatment of postoperative pain following total knee and hip arthroplasty: a meta-analysis

The efficacy of perioperative gabapentin for the treatment of postoperative pain following total knee and hip arthroplasty: a meta-analysis

Gabapentin for pain management after osmotic dilator insertion and prior to dilation and evacuation: A randomized controlled trial

Effectiveness, cost-effectiveness and safety of gabapentin versus placebo as an adjunct to multimodal pain regimens in surgical patients: protocol of a placebo controlled randomised controlled trial with blinding (GAP study)

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