Gabapentinoids for UAS Pain Management: Systematic Review and Meta-analysis

Introduction: Several studies have assessed the off-label usage of gabapentin and pregabalin for upper airway surgeries (UAS), but questions remain regarding the dosing regimen, pain relief, side effects, and efficacy. This systematic review with meta-analysis of RCTs and cohort studies was performed to assess the analgesic effect of gabapentinoids and evaluate potential for adverse effects in patients undergoing UAS.

Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. All RCTs and cohort studies from June 2002-2022 regarding treatment outcomes of gabapentinoids for UAS were extracted from Ovid Medline, Embase, SCOPUS, and Cochrane. Studies were subjected to a two-reviewer blinded screening, extraction, and appraisal process. Study quality assessment was implemented via the NIH study quality assessment tool. The primary outcome was decreased post-operative pain. Secondary outcomes included adverse drug events and opiate needs after surgery.

Results: Out of 310 studies, sixteen met inclusion criteria. Ten studies were adenotonsillectomies or tonsillectomies, five septoplasties, and one maxillomandibular advancement. There were 631 patients in the gabapentinoid group and 534 in the control. Appraisal revealed studies were of low (13) and moderate (3) risk of bias. Meta-analyses were performed for these categories: VAS pain score at 0-2 and 18-24 hours, opioid consumption post-surgery, and adverse drug events (e.g., nausea, vomiting, dizziness). Gabapentinoids significantly lowered pain levels 0-2 hours postoperatively, decreased opioid consumption, and nausea (p = 0.008, 0.002, and 0.03, respectively).

Conclusions: This review of current scientific literature supports peri-operative usage of gabapentinoids for UAS regarding treatment of pain, lowered analgesic requirement, and nausea levels. Future studies should include larger cohorts, implement standardized protocols regarding timing of events, medication dosing, objective measurements, proper blinding procedures for study personnel, and appropriate robust statistical analysis.