A systematic review and meta-regression analysis of prophylactic gabapentin for postoperative pain

Doleman, Brett; Heinink, T.P.; Faleiro, R.J.; Lund, Jonathan N.; Williams, John P.

Abstract

We searched MEDLINE, Embase, CINAHL, AMED and CENTRAL databases until December 2014 and included 133 randomised controlled trials of peri-operative gabapentin vs placebo. Gabapentin reduced mean (95% CI) 24-h morphine-equivalent consumption by 8.44 (7.26–9.62) mg, p < 0.001, whereas more specific reductions in morphine equivalents were predicted (R2 = 90%, p < 0.001) by the meta-regression equation: 3.73 + (−0.378 × control morphine consumption (mg)) + (−0.0023 × gabapentin dose (mg)) + (−1.917 × anaesthetic type), where ‘anaesthetic type’ is ‘1’ for general anaesthesia and ‘0’ for spinal anaesthesia. The type of surgery was not independently associated with gabapentin effect. Gabapentin reduced postoperative pain scores on a 10-point scale at 1 h, 2 h, 6 h, 12 h and 24 h by a mean (95% CI) of: 1.68 (1.35–2.01); 1.21 (0.88–1.55); 1.28 (0.98–1.57); 1.12 (0.91–1.33); and 0.71 (0.56–0.87), respectively, p < 0.001 for all. The risk ratios (95% CI) for postoperative nausea, vomiting, pruritus and sedation with gabapentin were: 0.78 (0.69–0.87), 0.67 (0.59–0.76), 0.64 (0.51–0.80) and 1.18 (1.09–1.28), respectively, p < 0.001 for all. Gabapentin reduced pre-operative anxiety and increased patient satisfaction on a 10-point scale by a mean (95% CI) of 1.52 (0.78–2.26) points and 0.89 (0.22–1.57) points, p < 0.001 and p = 0.01, respectively. All the effects of gabapentin may have been overestimated by statistically significant small study effects.

Citation

Doleman, B., Heinink, T., Faleiro, R., Lund, J. N., & Williams, J. P. (2015). A systematic review and meta-regression analysis of prophylactic gabapentin for postoperative pain. Anaesthesia, 70(10), https://doi.org/10.1111/anae.13179

• Journal Article Type: Article
• Acceptance Date: May 29, 2015
• Online Publication Date: Aug 24, 2015
• Publication Date: Sep 15, 2015
• Deposit Date: Feb 1, 2017
• Publicly Available Date: Feb 1, 2017
• Journal: Anaesthesia
• Print ISSN: 0003-2409
• Electronic ISSN: 1365-2044
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 70
• Issue: 10
• DOI: https://doi.org/10.1111/anae.13179
• Public URL: https://nottingham-repository.worktribe.com/output/761190
• Publisher URL: http://onlinelibrary.wiley.com/doi/10.1111/anae.13179/abstract
• Additional Information: This is the peer reviewed version of the following article: Doleman, B., Heinink, T. P., Read, D. J., Faleiro, R. J., Lund, J. N. and Williams, J. P. (2015), A systematic review and meta-regression analysis of prophylactic gabapentin for postoperative pain. Anaesthesia, 70: 1186–1204. doi:10.1111/anae.13179, which has been published in final form at http://onlinelibrary.wiley.com/doi/10.1111/anae.13179/abstract. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.
• Contract Date: Feb 1, 2017