Gabapentin and postoperative pain—a systematic review of randomized controlled trials

The objective of this systematic review was to evaluate the efficacy and tolerability of perioperative gabapentin administration for the control of acute postoperative pain. We searched Medline (1966–2006), the Cochrane Library (2006), Scopus, CINAHL and bibliographies from clinical trials and review articles. We included randomized controlled trials (RCTs) comparing gabapentin with inactive controls in surgical patients. Sixteen valid RCTs were included. Weighted mean difference (WMD) for postoperative pain intensity (0–100mm visual analogue scale) was −16.55mm at 6h and −10.87mm at 24h for treatment with a single preoperative dose of gabapentin 1200mg. Cumulative opioid consumption at 24h was also significantly decreased with gabapentin (WMD, −27.90mg). When gabapentin was administered at doses less than 1200mg, pain intensity was also lower at 6h (WMD, −22.43mm) and 24h (WMD, −13.18mm). Cumulative 24h opioid consumption was also lower (WMD, −7.25mg). Gabapentin was associated with an increased risk of sedation (Peto OR 3.86; 95% CI 2.50–5.94) but less opioid-related side effects such as vomiting (Peto OR 0.58; 95% CI 0.39–0.86) and pruritus (Peto OR 0.27; 95% CI 0.10–0.74). In conclusion, gabapentin has an analgesic and opioid-sparing effect in acute postoperative pain management when used in conjunction with opioids. © 2006 International Association for the Study of Pain.