Comparing Gabapentin and Pregabalin for Perioperative Pain Management in Lumbar Spine Surgery: A Systematic Review and Meta-Analysis.

Abstract

The effectiveness of gabapentin (GBP) and pregabalin (PGB) in mitigating acute postoperative pain following lumbar surgery remains understudied. This study assessed the effectiveness of GBP and PGB in mitigating acute postoperative pain following lumbar spine surgery, measured through patient-reported outcome measures such as visual analog scale (VAS) pain scores and the 24-hour morphine requirement. Online databases including PubMed/MEDLINE, Scopus, and Cochrane were searched for randomized clinical trials conducted among adults undergoing lumbar spine surgery who were treated with GBP, PGB, or placebo and reported VAS scores 24 hours postoperatively. Seven studies were identified involving 724 eligible patients. The mean age of the cohort was 53.97 years. No significant differences in VAS pain scores were noted 24 hours postoperatively for patients treated with GBP, PGB, or placebo. Of the 7 included studies, 3 directly compared the pain sparing effect of PGB and GBP. Again, no significant difference in 24-hour VAS scores was noted. However, patients treated with GBP had a significantly lower 24-hour morphine consumption (3.80 mg, 95% confidence interval: 2.00 mg-5.60 mg) than patients treated with placebo (11.03 mg, 95% confidence interval: 8.98 mg-13.08 mg). There was no significant difference in 24-hour morphine requirement between patients treated with PGB versus placebo or PGB versus GBP. Definitive conclusions regarding the efficacy of GBP and PGB in managing acute postoperative pain remain limited. Well-designed randomized controlled trials with standardized protocols are needed to clarify their role in perioperative pain management following lumbar spine surgery.