Gabapentin in procedure-specific postoperative pain management – preplanned subgroup analyses from a systematic review with meta-analyses and trial sequential analyses

BMC Anesthesiology

Research Article

Jørn Wetterslev¹  Jørgen Berg Dahl²  Maria Louise Fabritius²  Pernille Lykke Petersen³  Anja Geisler⁴  Ole Mathiesen⁴ 

[1] Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark;Department of Anaesthesiology and Intensive Care, Bispebjerg and Frederiksberg Hospitals, Bispebjerg bakke 23, 2400, Copenhagen, NV, Denmark;Department of Anaesthesiology, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark;Department of Anaesthesiology, Zealand University Hospital, Lykkebækvej 1, 4600, Køge, Denmark;

关键词: Gabapentin;    Gamma-Aminobutyric acid;    Analgesics;    Therapeutic use;    Pain;    Drug therapy;    Procedure-specific pain management;    Postoperative pain management;    Systematic review;    Subgroup analyses;   

DOI  :  10.1186/s12871-017-0373-8

 received in 2017-01-13, accepted in 2017-06-07,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundIt has been argued that postoperative pain treatment should be “procedure-specific”, since different analgesics may have specific effects dependent on the surgical procedure. The aim of the present subgroup analysis was to compare the beneficial and harmful effects of perioperative gabapentin treatment in different surgical procedures.MethodsRelevant databases were searched for randomized clinical trials (RCTs) comparing gabapentin versus placebo. Two authors independently screened titles and abstracts, extracted data and assessed risk of bias. The primary outcomes were differences in 24-h morphine consumption, and serious adverse events (SAE) between surgical procedures. These subgroup analyses were predefined in a PRISMA compliant systematic review registered at PROSPERO (ID: CRD42013006538). It was predefined that conclusions should primarily be based on trials classified as overall low risk of bias.ResultsSeventy-four RCTs with 5645 patients were included, assessing benefit and harm in cholecystectomy, hysterectomy, mastectomy, and arthroplasty surgery, spinal surgery, and thoracic surgery.Only eight of 74 trials were classified as overall low risk of bias limiting our ability to conclude on the estimates in most meta-analyses. The differences between surgical procedures in these trials were not statistically significant when tested for subgroup differences. Fifteen trials with 1377 patients reported a total of 59 SAEs, most of which were observed in the thoracic surgery group.ConclusionBoth beneficial and harmful effects in these subgroup analyses were influenced by bias and insufficient data, limiting conclusions. With these limitations, we could not adequately test for differences in beneficial or harmful outcomes between six surgical subgroups undergoing perioperative gabapentin treatment.

【 授权许可】

CC BY   
© The Author(s). 2017