title: The Effect of Preoperative Gabapentin on Postoperative Nausea and Vomiting: A Meta-Analysis.
abstract: BACKGROUND
  Preoperative gabapentin has been shown to improve postoperative pain and limit reliance on opioid analgesia. On the basis of an alternative mechanism, our group investigated the ability of preoperative gabapentin to prevent postoperative nausea and vomiting (PONV).
  
  
  METHODS
  We performed a meta-analysis of trials that reported outcomes on the effect of preoperative gabapentin on PONV end points in patients undergoing general anesthesia. In our primary analysis, we calculated the pooled antiemetic effects of preoperative gabapentin in studies with PONV as the primary end point. In our secondary analysis, we calculated the pooled effects in trials involving preoperative gabapentin that reported on the side effects, nausea and vomiting.
  
  
  RESULTS
  Among the trials designed with PONV as a primary end point (8 trials; n = 838), preoperative gabapentin was associated with a significant reduction in PONV (risk ratio [RR] = 0.60; 99% confidence interval [CI], 0.50-0.72; P < 0.0001), nausea (RR = 0.34; 99% CI, 0.20-0.56; P < 0.0001), and vomiting (RR = 0.34; 99% CI, 0.19-0.61; P = 0.0002) at 24 hours. Among all included trials (44 trials; n = 3489) that reported on the side effects, nausea and vomiting, similar reductions were noted in PONV with preoperative gabapentin administration. Subgroup analysis of trials excluding repeat dosing, thiopental induction, and nitrous oxide maintenance and including high-risk surgery resulted in similar PONV efficacy. Preoperative gabapentin is also associated with significantly increased rates of postoperative sedation (RR = 1.22; 95% CI, 1.02-1.47; P = 0.03) compared with control.
  
  
  CONCLUSIONS
  Preoperative gabapentin is associated with a significant reduction in PONV among studies designed to investigate this end point. Preoperative gabapentin should be considered not only as part of a multimodal approach to postoperative analgesia, but also for prevention of PONV.
authors.affiliation: From the Department of Anesthesiology, The Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Grant
authors.forename: HeeWon
authors.initials: H
authors.lastname: Lee
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Page
authors.forename: Deborah
authors.initials: D
authors.lastname: Hobson
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Wick
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Wu
mesh_terms: D000588:Amines / Q000008:administration & dosage*; D003509:Cyclohexanecarboxylic Acids / Q000008:administration & dosage*; D000077206:Gabapentin; D006801:Humans; D020250:Postoperative Nausea and Vomiting / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D016896:Treatment Outcome; D005680:gamma-Aminobutyric Acid / Q000008:administration & dosage*
chemical_list: D000588:Amines; D003509:Cyclohexanecarboxylic Acids; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin