Single dose oral gabapentin for established acute postoperative pain in adults
TLDR
Gabapentin 250 mg is statistically superior to placebo in the treatment of established acute postoperative pain, but the NNT of 11 for at least 50% pain relief over 6 hours with gabapentin250 mg is of limited clinical value and inferior to commonly used analgesics.Abstract:
Background
Gabapentin is an antiepileptic drug, also used in the treatment of neuropathic pain, which is the subject of a Cochrane review, currently under revision. Its efficacy in treating established acute postoperative pain has not been demonstrated.
Objectives
To assess the efficacy and safety of single dose oral gabapentin compared with placebo in established acute postoperative pain using methods that permit comparison with other analgesics.
Search methods
We searched Cochrane CENTRAL, MEDLINE, EMBASE, and the Oxford Pain Relief Database. Additional studies were sought from reference lists of retrieved articles and reviews. Clinical trials databases were searched for unpublished studies; clinical trial reports of several unpublished studies have been made public following litigation in the US.
Selection criteria
Single oral dose, randomised, double-blind, placebo-controlled trials of gabapentin for relief of established moderate to severe postoperative pain in adults.
Data collection and analysis
Studies were assessed for methodological quality and data extracted by two review authors independently. Numbers of participants with at least 50% of maximum possible total pain relief (TOTPAR) or summed pain intensity difference (SPID) with gabapentin or placebo were calculated and used to derive relative benefit (RB) or risk (RR), and number-needed-to-treat-to-benefit (NNT). Numbers of participants using rescue medication, and time to its use, were sought as additional measures of efficacy. Information on adverse events and withdrawals was collected.
Main results
Four unpublished studies met inclusion criteria; in three, participants had pain following dental surgery, and one followed major orthopaedic surgery; 177 participants were treated with a single dose of gabapentin 250 mg, 21 with gabapentin 500 mg, and 172 with placebo. At least 50% pain relief over 6 hours was achieved by 15% with gabapentin 250 mg and 5% with placebo; giving a RB of 2.5 (95% CI 1.2 to 5.0) and an NNT of 11 (6.4 to 35). Significantly fewer participants needed rescue medication within 6 hours with gabapentin 250 mg than with placebo; NNT to prevent use 5.8. About one third of participants reported adverse events with both gabapentin 250 mg and placebo. No serious adverse events occurred with gabapentin.
Authors' conclusions
Gabapentin 250 mg is statistically superior to placebo in the treatment of established acute postoperative pain, but the NNT of 11 for at least 50% pain relief over 6 hours with gabapentin 250 mg is of limited clinical value and inferior to commonly used analgesics. Gabapentin 250 mg is not clinically useful as a stand-alone analgesic in established acute postoperative pain, though this is probably the first demonstration of analgesic effect of an antiepileptic in established acute pain.read more
Citations
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Journal ArticleDOI
Management of postoperative pain: A clinical practice guideline from the american pain society, the american society of regional anesthesia and pain medicine, and the american society of anesthesiologists' committee on regional anesthesia, executive committee, and administrative council.
Roger Chou,Debra B. Gordon,Oscar A. de Leon-Casasola,Jack M. Rosenberg,Stephen W. Bickler,Timothy J. Brennan,Todd Carter,Carla L. Cassidy,Eva Chittenden,Ernest Degenhardt,Scott R. Griffith,Renee C.B. Manworren,Bill McCarberg,Robert R. Montgomery,Jamie D. Murphy,Melissa F. Perkal,Santhanam Suresh,Kathleen A. Sluka,Scott A. Strassels,Richard C. Thirlby,Eugene R. Viscusi,Gary A. Walco,Lisa Warner,Steven J. Weisman,Christopher L. Wu +24 more
TL;DR: The American Pain Society, with input from the American Society of Anesthesiologists, developed a clinical practice guideline to promote evidence-based, effective, and safer postoperative pain management in children and adults.
Reference EntryDOI
Gabapentin for chronic neuropathic pain and fibromyalgia in adults
TL;DR: Gabapentin provides pain relief of a high level in about a third of people who take if for painful neuropathic pain, and more conservative estimates of efficacy resulted from using better definitions of efficacy outcome at higher, clinically important, levels.
Journal ArticleDOI
Gabapentin for chronic neuropathic pain in adults
Philip J Wiffen,Sheena Derry,Rae Frances Bell,Andrew S.C. Rice,Thomas R. Tölle,Tudor Phillips,R Andrew Moore +6 more
TL;DR: Gabapentin is commonly used to treat neuropathic pain (pain due to nerve damage) and adverse effects in adults as discussed by the authors, and it has been shown that patients with substantial pain relief (at least 50% pain relief over baseline or very much improved on Patient Global Impression of Change scale (PGIC)) were more common with gabapentin than with placebo.
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Enhanced recovery after surgery in microvascular breast reconstruction
Niles J. Batdorf,Valerie Lemaine,Jenna K. Lovely,Karla V. Ballman,Whitney J. Goede,Jorys Martinez-Jorge,Andria L. Booth-Kowalczyk,Pamela L. Grubbs,Lisa D. Bungum,Michel Saint-Cyr +9 more
TL;DR: The initiation of an ERAS pathway significantly decreased hospital LOS in this study and significantly decreased the amount of opioids used postoperatively by 71%, without a consequent increase in patient-reported pain.
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