Acute postoperative pain: higher pregabalin and gabapentin doses are more effective


  • Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Single-dose preoperative administration of pregabalin and gabapentin showed dose-response relationship for opioid consumption and postoperative pain.
  • Higher doses were more effective.

Why this matters

  • The role of pregabalin or gabapentin in acute postoperative pain management is unknown.

Study design

  • Network meta-analysis of 79 randomised controlled trials with 6201 patients receiving single-dose premedication.
  • Funding: Natural Science Foundation of Zhejiang Province.

Key results

  • Compared with placebo, 24-hour opioid consumption decreased consistently with increase in the dose of pregabalin or gabapentin:
    • pregabalin 150 mg: standard mean difference (SMD), –1.66 (95% CI, –2.28 to –1.03);
    • pregabalin 300 mg: SMD, –1.86 (95% CI, –2.68 to –1.03);
    • gabapentin 300 mg: SMD, –0.98 (95% CI, –1.86 to –0.10);
    • gabapentin 600 mg: SMD, –1.14 (95% CI, –1.77 to –0.50);
    • gabapentin 900 mg: SMD, –1.64 (95% CI, –2.60 to –0.67);
    • gabapentin 1200 mg: SMD, –1.86 (95% CI, –2.51 to –1.21).
  • For 24-hour pain score at rest, higher doses were effective in decreasing the pain:
    • pregabalin 150 mg (SMD, –0.96; –1.32 to –0.60)  and 300 mg (SMD, –0.50; 95% CI, –0.93 to –0.07).
    • gabapentin 900 mg (SMD, –1.11; 95% CI, –1.98 to –0.24) and 1200 mg (SMD, –0.89; 95% CI, –1.36 to –0.43).
  • Adverse reactions varied with different doses.

Limitations

  • Lack of head-to-head comparison between pregabalin and gabapentin.

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