Perioperative Use of Gabapentinoids for the Management of Postoperative Acute Pain

Anesthesiology - Tập 133 Số 2 - Trang 265-279 - 2020
Michael Verret1,2,3,4,5,6,7,8,9,10,11,12, François Lauzier1,2,3,4,5,6,7,8,9,10,11,12, Ryan Zarychanski1,2,3,4,5,6,7,8,9,10,11,12, Caroline Perron1,2,3,4,5,6,7,8,9,10,11,12, Xavier Savard1,2,3,4,5,6,7,8,9,10,11,12, Anne-Marie Pinard1,2,3,4,5,6,7,8,9,10,11,12, Guillaume Leblanc1,2,3,4,5,6,7,8,9,10,11,12, Marie-Joëlle Cossi1,2,3,4,5,6,7,8,9,10,11,12, Xavier Neveu1,2,3,4,5,6,7,8,9,10,11,12, Alexis F. Turgeon1,2,3,4,5,6,7,8,9,10,11,12
1From the Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, CHU de Québec - Université Laval Research Center, Québec City, Québec, Canada (M.V., F.L., C.P., X.S., A.-M.P., G.L., M.-J.C., X.N., A.F.T.)
2Members of the Canadian Perioperative Anesthesia Clinical Trials (PACT) Group are listed in the appendix.
3Submitted for publication September 10, 2019. Accepted for publication May 20, 2020. Published online first on June 26, 2020. Corrected on November 13, 2020.
4Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site ().
5This article has a related Infographic on p. 17A.
6This article has a visual abstract available in the online version.
7This article has an audio podcast.
8This article is accompanied by an editorial on p. 251.
9This article is featured in “This Month in Anesthesiology,” page 1A.
10the Department of Haematology and Medical Oncology, Cancer Care Manitoba, Winnipeg, Manitoba, Canada (R.Z.).
11the Department of Internal Medicine, Section of Critical Care, University of Manitoba, Winnipeg, Manitoba, Canada (R.Z.)
12the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine (M.V., F.L., A.-M.P., G.L., A.F.T.), the Department of Medicine (F.L.), Faculty of Medicine, and the Interdisciplinary Research Centre for Rehabilitation and Social Integration (A.-M.P.), Université Laval, Québec City, Québec, Canada

Tóm tắt

BackgroundWidely 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.MethodsRandomized 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.ResultsIn 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.ConclusionsNo 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 PerspectiveWhat We Already Know about This TopicWhat This Article Tells Us That Is New

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Anesthesiology

Tập 133 Số 2

265-279

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