(I-579) Efficacy and Safety of Different Gabapentin and Pregabalin Concentration for Perioperative Pain Control in Patients undergoing Spine Surgery: A Systematic Review and Network Meta-analysis

Introduction: Previous studies have shown the effectiveness and safety of pregabalin and gabapentin as perioperative pain-control medication for patients undergoing spine surgery. However, direct or indirect comparisons between the different dosages of pregabalin and gabapentin are scarce in the literature. This study aims to compare pain, opioid consumption, and adverse events among different dosages of pregabalin and gabapentin, in patients undergoing spine surgery.

Methods: We searched Ovid/MEDLINE, Embase, Cochrane CENTRAL, Cochrane database of systemic reviews, and Scopus for randomized controlled trials comparing Visual analog scale (VAS) among patients who used gabapentin or pregabalin preoperatively, up to August 2021. Two authors extracted data and appraised the risk of bias in included studies. The primary outcome was VAS and secondary outcomes were adverse events. We performed pairwise meta-analyses to compare differences between medications and network meta-analyses using frequentist random-effects models to compare through indirect evidence. We used the surface under the cumulative ranking curve (SUCRA) to determine the probability of different dosages of pregabalin or gabapentin ranking best in terms of VAS, opioid consumption, and adverse events.

Results: Twenty-seven randomized controlled trials with 2,231 patients were included in the systematic review and network meta-analysis. Compared to placebo, the VAS was lower with gabapentin 1200mg/day, followed by gabapentin 900mg/day, gabapentin 300mg/day, gabapentin 600mg/day, pregabalin 300mg/day, pregabalin 150mg/day, and pregabalin 75mg/day. For adverse events, there is no statistical difference in adverse events (nausea, vomiting, and dizziness) among all treatments. No substantial inconsistency between direct and indirect evidence was detected for all outcomes.

Conclusion : Preoperative use of gabapentin and pregabalin can alleviate postoperative pain for patients undergoing spine surgery and gabapentin 1200mg/day has the lowest VAS score among all doses of gabapentin and pregabalin. Further head-to-head prospective studies should confirm the comparative safety profiles for gabapentin and pregabalin.

How to Improve Patient Care: Both gabapentin and pregabalin can alleviate postoperative pain for patients undergoing spine surgery with the best pain control with gabapentin without higher adverse events compared to other doses.