Pre‐emptive administration of gabapentinoids to reduce postoperative pain and opioid usage following oral and maxillofacial surgical procedures

Abstract

Aim:The objective of this review was to assess the efficiency of pre-emptive gabapentinoid administration on postoperative pain and opioid consumption in patients undergoing oral surgical procedures. Material and Methods:A review of the literature was performed using various indexed databases. A total of six randomized controlled trials (RCTs) were included in the current systematic review which compared postoperative analgesic and/or opioid-sparing effect of gabapentinoids (either alone or in combination with other drugs).Results: Out of the six studies included, four studies showed a statistically significant reduction in pain scores while three studies showed a significant reduction in opioid consumption postoperatively. All studies included reported that adverse effects like nausea and vomiting were higher in the placebo group except for one study, which reported a higher frequency of adverse events in the pregabalin group. The overall risk of bias was low in five studies and moderate in one study. Conclusions:In brief, gabapentinoids when administered pre-emptively in patients undergoing oral surgical procedures reduced postoperative pain and opioid consumption.However, there is a need for further research to come to a consensus regarding the dosage and timing of the pre-emptive gabapentinoids administration. Also, surgery specific research is needed in future studies. K E Y W O R D Saddiction, analgesia, opioids, oral surgery, pain, pre-emptive Clinical RelevanceScientific rationale for study: There is an increasing body of evidence supporting the preoperative use of gabapentinoids for reducing postoperative pain and opioid use. Several systematic reviews and meta-analyses have been published regarding the preoperative use of gabapentinoids in various general surgery procedures whereas there has not been any review regarding their use in oral surgery procedures to our knowledge. This is the motivation behind conducting the current review. Principal findings: Gabapentinoids when given pre-emptively reduce the pain scores and opioid requirements in the postsurgical period with very few adverse effects.

Pain management after dental extractions – non-opioid combination analgesics minimize opioid use for acute dental pain

“…A Cochrane review demonstrated efficacy of gabapentin for acute pain after dental extractions 32 . A recent systematic review indicates that preoperative use of gabapentinoids reduces pain and opioid consumption after various oral surgeries including third molar removals 33 . Gabapentioids are not metabolized in the body and is excreted through the kidney in its original form, providing safety for combination with other analgesics 53 .…”

“…Gabapentinoids, including gabapentin and pregabalin, are structural derivatives of g amino butyric acid and act on both central and peripheral sensory pathways to inhibit central sensitization and peripheral pain transmission 51 . Though gabapentinoids are classified as antiepileptics and were approved primarily for neuropathic pain such as postherpetic neuralgia and fibromyalgia, numerous clinical trials have demonstrated their efficacies for acute pain and for reduction of opioid consumption after major surgery 32,33,52 . A Cochrane review demonstrated efficacy of gabapentin for acute pain after dental extractions 32 .…”

“…A Cochrane review demonstrated efficacy of gabapentin for acute pain after dental extractions 32 . A recent systematic review indicates that preoperative use of gabapentinoids reduces pain and opioid consumption after various oral surgeries including third molar removals 33 .…”

“…In response to the clear need for effective non-opioid analgesics, HDUC systematically reviewed existing evidence that inclusion of gabapentin in combination analgesics may benefit patients who could not tolerate either NSAIDs or APAP. Clinical trials have established the efficacy of gabapentin for acute postoperative pain [32][33][34][35][36] , but the evidence on the effectiveness of gabapentin combination analgesics in the real-world dental setting is limited to empirical experiences and clinical impressions.…”