Ajit S Rai1, James S Khan2, Jasneet Dhaliwal3, Jason W Busse4, Stephen Choi5, P J Devereaux6, Hance Clarke7. 1. Wayne State University, School of Medicine, Detroit, MI, USA; Department of Anesthesia and Pain Medicine, Toronto General Hospital, Toronto, Canada. Electronic address: ajitrai99@gmail.com. 2. Department of Anesthesia, University of Toronto, Toronto, Canada. 3. Faculty of Health Sciences, McMaster University, Hamilton, Canada. 4. Michael G. DeGroote Institute for Pain Research and Care, Hamilton, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada; Department of Anesthesia, McMaster University, Hamilton, Canada. 5. Department of Anesthesia, University of Toronto, Toronto, Canada; Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Canada. 6. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada; Department of Medicine, McMaster University, Hamilton, Canada; Population Health Research Institute, Hamilton, Canada. 7. Department of Anesthesia and Pain Medicine, Toronto General Hospital, Toronto, Canada; Department of Anesthesia, University of Toronto, Toronto, Canada.
Abstract
BACKGROUND AND OBJECTIVE: Breast cancer surgery is associated with acute and chronic pain. We sought to systematically evaluate the effects of gabapentin and pregabalin on postoperative pain among patients undergoing breast cancer surgery. DATABASES AND DATA TREATMENT: We searched MEDLINE, EMBASE, CENTRAL, Web of Science, and ProQuest from the inception of each database to November 2015. We included studies enrolling adult patients undergoing breast cancer surgery who were randomly assigned to preoperative gabapentin or pregabalin versus placebo or active control and assessed acute (≤24 h) or chronic (≥2 months) pain. We conducted meta-analyses when possible and rated the quality of evidence (QoE) by using the GRADE approach. RESULTS: Twelve studies were eligible for review, of which eight evaluated gabapentin (n = 516) and four pregabalin (n = 209). Gabapentin reduced pain scores in the recovery room (mean difference [MD] -1.68 on a 0-10 Numeric Rating Scale (NRS), 95% CI -2.59 to -0.77; minimally important difference is 1 point; relative risk [RR] for mild pain (<4/10) 1.71, 95% CI 1.33-2.02; moderate QoE) and 24 h postoperatively (MD -0.52, 95% CI -1.02 to -0.01; RR for mild pain 1.07, 95% CI 1.00-1.13; very low QoE). Pregabalin reduced pain and morphine consumption in the recovery room (MD -6.71 mg, 95% CI -10.73 to -2.70; low QoE). No significant difference was observed in pain score at 24 h (MD -0.38, 95%, CI -0.96 to 0.21; moderate QoE). Neither drug reduced the rate of chronic postoperative pain. CONCLUSIONS: Gabapentin and pregabalin seem to reduce opioid consumption in the recovery room. Gabapentin, but not pregabalin, reduces pain at 24 h after breast cancer surgery. Neither drug affects the development of chronic postoperative pain. SIGNIFICANCE: Gabapentin and pregabalin administered perioperatively in patients undergoing breast cancer surgery improve acute postoperative pain as indicated by the reduction in opioid consumption. Further data are needed on reducing chronic postoperative pain.
BACKGROUND AND OBJECTIVE: Breast cancer surgery is associated with acute and chronic pain. We sought to systematically evaluate the effects of gabapentin and pregabalin on postoperative pain among patients undergoing breast cancer surgery. DATABASES AND DATA TREATMENT: We searched MEDLINE, EMBASE, CENTRAL, Web of Science, and ProQuest from the inception of each database to November 2015. We included studies enrolling adult patients undergoing breast cancer surgery who were randomly assigned to preoperative gabapentin or pregabalin versus placebo or active control and assessed acute (≤24 h) or chronic (≥2 months) pain. We conducted meta-analyses when possible and rated the quality of evidence (QoE) by using the GRADE approach. RESULTS: Twelve studies were eligible for review, of which eight evaluated gabapentin (n = 516) and four pregabalin (n = 209). Gabapentin reduced pain scores in the recovery room (mean difference [MD] -1.68 on a 0-10 Numeric Rating Scale (NRS), 95% CI -2.59 to -0.77; minimally important difference is 1 point; relative risk [RR] for mild pain (<4/10) 1.71, 95% CI 1.33-2.02; moderate QoE) and 24 h postoperatively (MD -0.52, 95% CI -1.02 to -0.01; RR for mild pain 1.07, 95% CI 1.00-1.13; very low QoE). Pregabalin reduced pain and morphine consumption in the recovery room (MD -6.71 mg, 95% CI -10.73 to -2.70; low QoE). No significant difference was observed in pain score at 24 h (MD -0.38, 95%, CI -0.96 to 0.21; moderate QoE). Neither drug reduced the rate of chronic postoperative pain. CONCLUSIONS: Gabapentin and pregabalin seem to reduce opioid consumption in the recovery room. Gabapentin, but not pregabalin, reduces pain at 24 h after breast cancer surgery. Neither drug affects the development of chronic postoperative pain. SIGNIFICANCE: Gabapentin and pregabalin administered perioperatively in patients undergoing breast cancer surgery improve acute postoperative pain as indicated by the reduction in opioid consumption. Further data are needed on reducing chronic postoperative pain.
Authors: Raymond C Tait; Kim Zoberi; McKenzie Ferguson; Kimberly Levenhagen; Rebecca A Luebbert; Kevin Rowland; Gretchen B Salsich; Christopher Herndon Journal: J Pain Date: 2018-06-30 Impact factor: 5.820