Preoperative pregabalin or gabapentin for postoperative acute and chronic pain among patients undergoing breast cancer surgery: A systematic review and meta-analysis of randomized controlled trials

Publication date: Available online 9 June 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Ajit S. Rai, James S. Khan, Jasneet Dhaliwal, Jason W. Busse, Stephen Choi, P.J. Devereaux, Hance Clarke
Background and ObjectiveBreast cancer surgery is associated with acute and chronic pain. We sought to systematically evaluate the effect of gabapentin and pregabalin on post-surgical pain among patients undergoing breast cancer surgery.Databases and Data TreatmentWe searched MEDLINE, EMBASE, CENTRAL, Web of Science, and ProQuest from inception to November 2015. Studies enrolling adult patients undergoing breast cancer surgery randomly assigned to preoperative gabapentin or pregabalin versus placebo or active control, and assessed acute (≤24 hours) or chronic (≥2 months) pain, were included. We conducted meta-analyses when possible, and rated quality of evidence (QoE) using the GRADE approach.ResultsTwelve studies were eligible for review. 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 NRS, 95% CI -2.59 to -0.77; MID is 1-point; relative risk [RR] for mild pain (<4/10) 1.71, 95% CI 1.33 to 2.02; moderate QoE) and 24-hours postoperatively (MD -0.52, 95% CI -1.02 to -0.01; RR for mild pain 1.07, 95% CI 1.00 to 1.13; very low QoE). Pregabalin reduced pain and morphine consumption in recovery (MD -6.71 mg, 95% CI -10.73 to -2.70; low QoE). There was no difference in pain at 24-hours (MD -0.38, 95%, CI -0.96 to 0.21; moderate QoE). Neither drug reduced the rate of chronic post-surgical pain.ConclusionsGabapentin and pregabalin seem to reduce opioid consumption in the recovery room. Gabapentin, but not pregabalin, reduces pain at 24 hours after breast cancer surgery. Neither drug affects the development of chronic post-surgical pain.SignificancePregabalin and gabapentin given perioperatively in breast cancer surgery patients improves postoperative acute pain as indicated by reduction in opioid consumption. Further data is needed on reducing chronic post-surgical pain.



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