Perioperative Gabapentin After Benign Anorectal Surgery: Statistically Significant but Clinically Uncertain? A Systematic Review and Meta-Analysis.
Bernardo Fontel Pompeu, Fábio Henrique Nogueira Nóbrega Alves, Bianca Vaz Micherino et al.
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In 30 seconds
This systematic review and meta-analysis assessed perioperative gabapentin versus placebo or standard analgesia in patients undergoing benign anorectal surgery, including randomised trials and observational cohorts. Six studies enrolled 504 patients; four studies with 415 patients contributed 24-hour pain scores. Gabapentin was associated with lower pain on the Visual Analogue Scale at 24 hours (MD = -2.10 cm; 95% CI -3.98 to -0.22; P = 0.029), but heterogeneity was very high (I 2 = 99.2%). The authors judged the evidence very low certainty and the clinical relevance uncertain.
Key findings
- Across four studies and 415 patients, 24-hour VAS pain was lower with gabapentin (MD = -2.10 cm; 95% CI -3.98 to -0.22; P = 0.029).
- Heterogeneity in the pooled 24-hour pain result was high (I 2 = 99.2%).
- The Bayesian analysis estimated a 99.8% posterior probability of benefit, while the authors rated the evidence very low certainty.
Why it matters
Postoperative pain after anorectal surgery can contribute to delayed discharge and greater opioid use. Although the pooled analysis detected lower 24-hour pain scores with gabapentin, substantial between-study heterogeneity and very low certainty make the size and practical importance of benefit difficult to establish. The findings therefore inform consideration of perioperative analgesia but do not establish a reliable clinical advantage.
What to keep in mind
The evidence was rated very low certainty, and the pooled pain estimate showed substantial heterogeneity (I 2 = 99.2%). The 24-hour outcome was available from only four of the six included studies.