Safety And Efficacy Of Gabapentin In The Management Of Acute Postoperative Pain-A Systematic Qualitative And Quantitative Review.
Vydyanathan A MD, Subramaniam K MD, Bashour A MD.
Division of Anesthesiology, Cleveland Clinic Foundation, Cleveland, OH, USA

Background: Gabapentin is a gamma-amino butyric acid analog that selectively interacts with the alpha(2)delta subunit of voltage-dependent calcium channels. Initially used as an anti-convulsant, gabapentin has been shown to be useful in the treatment of neuropathic pain (1). Animal studies and recent human clinical trials suggest that gabapentin may have a role in acute postsurgical pain management (2). We performed a qualitative and quantitative systematic review of available randomized, doubleblinded and placebo controlled clinical trials investigating the efficacy and safety of gabapentin as a
perioperative analgesic.
Methods: Literature search using terms such as gabapentin, postoperative pain, postoperative analgesia was done using Medline (1966-2005). Published original articles were read by two independent investigators and ranked according to a quality score (3). The following data were obtained; randomization, double blinding, number of patients, grouping, type of surgery, intraoperative and postoperative analgesics used, pain scores, time for request of first analgesia, supplemental analgesics required and adverse events. Analgesic efficacy was estimated by the significance of the outcome measures reported in the clinical studies and calculation of the weighted mean difference in VAS scores for the initial 24 postoperative hours. Side effects were combined to increase the power of observations. Data analysis was done using Review manager 4.2.7.
Results: 10 studies were found and a total of 816 patients were studied, of whom 412 received gabapentin. All studies used oral gabapentin preoperatively. Oral gabapentin significantly reduced pain scores in all studies (WMD 95% CI: -1.23 (-1.64, -0.81), p-value < 0.0001, Figure below) and decreased supplemental analgesic requirement in 9 studies.

Cumulative analysis did not reveal any significant difference in adverse events between gabapentin and placebo groups (Table below).

Conclusions: We conclude that gabapentin significantly improves postoperative analgesia after various surgical procedures without increasing side effects. The role of gabapentin in multimodal postoperative analgesia needs to be studied in future clinical trials.
References:
1. Caraceni A, et al. J Clin Oncol.2004: 22(14); 2909-17.
2. Field MJ, et al. J. Pharmacol. Exp. Ther. 1997: 282(3); 1242-6.
3. Jadad AR, et al. Control Clin. Trials 1996: 17; 1-12.

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