title: Gabapentin for post-operative pain management - a systematic review with meta-analyses and trial sequential analyses.
abstract: Perioperative pain treatment often consist of combinations of non-opioid and opioid analgesics, 'multimodal analgesia', in which gabapentin is currently used. The aim was to document beneficial and harmful effects of perioperative gabapentin treatment.
  
  
  
  Randomized clinical trials comparing gabapentin vs. placebo or active placebo in adult surgical patients receiving gabapentin perioperatively were included. This review was conducted using Cochrane standards, trial sequential analysis (TSA), and Grading of Recommendations Assessment, Development, and Evaluation (GRADE). The primary outcomes were 24-h opioid consumption and incidence of serious adverse events (SAE).
  
  
  
  One hundred and thirty-two trials with 9498 patients were included. Thirteen trials with low risk of bias reported a reduction in 24-h opioid consumption of 3.1 mg [0.5, 5.6] [corrected]. In the analysis of gabapentin as add-on analgesic to another non-opioid analgesic regimen found a mean reduction in 24-h morphine consumption of 1.2 mg [-0.3, 2.6; TSA-adjusted CI: -0.3, 2.6] in trials with low risk of bias. [corrected]. Nine trials with low risk of bias reported a risk ratio of SAEs of 1.61 [0.91; 2.86; TSA-adjusted CI: 0.57, 4.57].
  
  
  
  Based on GRADE assessment of the primary outcomes in trials with low risk of bias, the results are low or very low quality of evidence due to imprecision, inconsistency, and in some outcomes indirectness. Firm evidence for use of gabapentin is lacking as clinically relevant beneficial effect of gabapentin may be absent and harm is imminent, especially when added to multimodal analgesia.
authors.affiliation: Department of Anaesthesiology, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
authors.forename: M L
authors.initials: ML
authors.lastname: Fabritius
authors.affiliation: Department of Anaesthesiology, Zealand University Hospital, Køge, Denmark.
authors.forename: A
authors.initials: A
authors.lastname: Geisler
authors.affiliation: Department of Anaesthesiology, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
authors.forename: P L
authors.initials: PL
authors.lastname: Petersen
authors.affiliation: Department of Anaesthesiology and Danish Pain Research Centre, Aarhus University Hospital, Aarhus C, Denmark.
authors.forename: L
authors.initials: L
authors.lastname: Nikolajsen
authors.affiliation: Department of Anaesthesiology, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
authors.forename: M S
authors.initials: MS
authors.lastname: Hansen
authors.affiliation: Department of Anaesthesiology, Helsinki University Central Hospital, Jorvi Hospital, Helsinki, Finland.
authors.forename: V
authors.initials: V
authors.lastname: Kontinen
authors.affiliation: The Pain Clinic, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: K
authors.initials: K
authors.lastname: Hamunen
authors.affiliation: Department of Anaesthesiology and Intensive Care Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospitals, Copenhagen, Denmark.
authors.forename: J B
authors.initials: JB
authors.lastname: Dahl
authors.affiliation: Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: J
authors.initials: J
authors.lastname: Wetterslev
authors.affiliation: Department of Anaesthesiology, Zealand University Hospital, Køge, Denmark.
authors.forename: O
authors.initials: O
authors.lastname: Mathiesen
mesh_terms: D000588:Amines / Q000009:adverse effects / Q000627:therapeutic use*; D000700:Analgesics / Q000627:therapeutic use*; D015982:Bias; D003509:Cyclohexanecarboxylic Acids / Q000009:adverse effects / Q000627:therapeutic use*; D000077206:Gabapentin; D006801:Humans; D010149:Postoperative Pain / Q000188:drug therapy*; D005680:gamma-Aminobutyric Acid / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000588:Amines; D000700:Analgesics; D003509:Cyclohexanecarboxylic Acids; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin