Effectiveness of gabapentinoids in orthopedic surgeries: a systematic review and meta-analysis of postoperative pain, and opioid-sparing effects

Gabapentinoids, including gabapentin and pregabalin, are increasingly used in perioperative settings to manage postoperative pain. Despite their widespread use, the clinical evidence regarding the treatment of gabapentinoids in terms of improvement of pain, reduction of opioid consumption and the enhancement of functional recovery is inconclusive. This systematic review and meta-analysis aimed at evaluating the efficacy of gabapentinoids in orthopedic surgeries, with a focus on their role as standalone interventions without the influence of other analgesic modalities like spinal anesthesia or nerve blocks. We conducted a search of electronic databases, including PubMed, Scopus, and Web of Science, to identify randomized controlled trials (RCTs) to identify randomized controlled trials (RCTs) evaluating the use of gabapentinoids in orthopedic surgeries. Fourteen RCTs which met the inclusion criteria were included in the meta-analysis mean differences (WMDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated for continuous and binary outcomes, respectively. Data on postoperative pain reduction, opioid-sparing effects, and adverse events were extracted and analyzed using a random-effects model. Weighted mean differences (WMDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated for continuous and binary outcomes, respectively. Heterogeneity was assessed using the I2 statistic. The meta-analysis revealed that gabapentinoids significantly reduced postoperative pain intensity at 24 hours (WMD: -0.57). Although statistically significant, the mean reductions in the mean reductions in pain intensity did not exceed the minimal clinically important difference (MCID) of 1.0 point on a 0–10 numeric rating scale, indicating limited clinical relevance. Gabapentinoids were also followed by a lower risk of nausea (RR: 0.68) but an increased likelihood of dizziness (RR: 1.25). Heterogeneity was high in the category of pain (I2 >50%), which suggested variability in the study designs and the involved patients. While gabapentinoids demonstrate statistically significant benefits by reducing post-operative pain and opioid use in orthopedic surgeries, their clinical effect is still limited.