Is gabapentin effective and safe in open hysterectomy? A PRISMA compliant meta-analysis of randomized controlled trials.

BACKGROUND: Pain management after open hysterectomy has been investigated for years. Owing to the effect of significant analgesic, gabapentin was often administrated for pre-emptive analgesia. However, the relationship between gabapentin and postoperative pain after open hysterectomy is still controversial. This meta-analysis was applied to assess the efficacy of pre-emptive use of gabapentin in open hysterectomy.

METHODS: This meta-analysis of randomized controlled trials (RCTs) was performed to compare the use of gabapentin with placebo in open hysterectomy regarding (1) the mean difference (MD) of postoperative opioid requirements; (2) the changes of visual analogue scale (VAS) scores in two groups; and (3) incidence rate of adverse effects. Systematic searches of all related literatures was conducted using the following databases: MEDLINE, EMBASE, ClinicalTrials.gov and Web of Science. Only randomized controlled trials (RCTs) for open hysterectomy were included. The MD of postoperative opioid requirements and VAS scores, relative risk (RR) of incidence rate of adverse effects in the gabapentin group versus placebo group were extracted throughout the study.

RESULTS: Fourteen trials were included in this meta-analysis. The total opioid consumption at 24h was a less in gabapentin group. (MD=-11.61, 95% CI: -16.71 to -6.51, P=0.00) The visual analogue scale (VAS) score at 4, 12 and 24h were less in the gabapentin group. (MD=-16.83, 95% CI: -22.88 to -10.77, P=0.00), (MD=-17.45, 95% CI: -21.83 to -13.08, P=0.00), (MD=-9.83, 95% CI: -13.31 to -6.35, P=0.00) The incidence rate of vomiting and nausea were significantly less in gabapentin groups. (RR 0.13, 95% CI 0.45 to 0.73, P=0.00), (RR 0.67, 95% CI 0.49 to 0.93, P=0.02). Compared with placebo, gabapentin achieved higher patient satisfaction. (MD=20.43, 95% CI: 12.42 to 28.44, P<0.00).

CONCLUSION: This meta-analysis suggested that the employment of gabapentin was efficacious in reduction of postoperative opioid consumption, VAS score and some side effects after open hysterectomy.