Use of gabapentin for perioperative pain control -- a meta-analysis.

BACKGROUND Gabapentin, an anticonvulsant, has recently been suggested as an effective postoperative 'analgesic' agent. The objective of the present study was to examine the analgesic effectiveness, opioid-sparing effects and side effects associated with the use of gabapentin in a perioperative setting. METHODS Following the Quality of Reporting of Meta-analyses recommendations, nine electronic databases until February 2006 were searched, without language restriction, for randomized controlled trials comparing gabapentin with control for postoperative pain control. Outcome measures, namely, 24 h cumulative opioid consumption, visual analogue scale pain scores and adverse effects, were expressed as odds ratios, ratio of means or weighted mean differences (as appropriate), which were aggregated under the fixed or random effects models. RESULTS Gabapentin caused a 35% reduction in total opioid consumption over the first 24 h following surgery (ratio of means 0.65, 95% CI 0.59 to 0.72), a significant reduction in postoperative pain at rest (in the first 24 h) and with movement (at 2 h, 4 h and 12 h), regardless of whether treatment effects were expressed as ratios of means or weighted mean differences, and a reduction of vomiting (relative risk [RR] 0.73, 95% CI 0.56 to 0.95) and pruritus (RR 0.30, 95% CI 0.13 to 0.70). It was associated with a significant increase in dizziness (RR 1.40, 95% CI 1.06 to 1.84) and an increase in sedation of borderline significance (RR 1.65, 95% CI 1.00 to 2.74). CONCLUSION Gabapentin improves the analgesic efficacy of opioids both at rest and with movement, reduces analgesic consumption and opioid-related adverse effects, but is associated with an increased incidence of sedation and dizziness.