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doi: 10.1097/ALN.0000000000000297

Gabapentinoids and Postsurgical Pain: Safe and Effective?

van Schalkwyk, Johan M. F.R.A.C.P.

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To the Editor:

The recent review on perioperative gabapentinoids by Schmidt et al.1 shows several inconsistencies with the findings of the literature they review. The authors claim that “gabapentinoids are generally very well tolerated,” an assertion contradicted by even the most enthusiastic of the three old meta-analyses they cite, where there was a threefold increase in sedation or drowsiness2; they also fail to report accurately the findings of a more recent analysis in saying “gabapentin is effective in already established acute postoperative pain even when dosed solely postoperatively.”3 This Cochrane analysis actually says “... but the NNT of 11 for at least 50% pain relief over 6 hours with gabapentin 250 mg is of limited clinical value and inferior to commonly used analgesics.” The overall tenor of the review is that gabapentin is substantially effective, both in the management of acute postoperative pain and in the prevention of chronic postsurgical pain. Neither contention is supported by independent analyses.4*
Given the early history of inappropriate promotion of gabapentin for off-label use for pain, it seems wise to be particularly vigilant for inconsistencies when assessing the drug’s apparent benefits.
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Competing Interests

The author declares no competing interests.
Johan M. van Schalkwyk, F.R.A.C.P.
, Auckland City Hospital, Auckland, New Zealand.
* Therapeutics Initiative. Gabapentin for pain: New evidence from hidden data. Therapeutics Letter 2009; 75. University of British Columbia. Available at: Accessed November 12, 2013. Cited Here...
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1. Schmidt PC, Ruchelli G, Mackey SC, Carroll IR. Perioperative gabapentinoids: Choice of agent, dose, timing, and effects on chronic postsurgical pain. ANESTHESIOLOGY. 2013;119:1215–21

2. Hurley RW, Cohen SP, Williams KA, Rowlingson AJ, Wu CL. The analgesic effects of perioperative gabapentin on postoperative pain: A meta-analysis. Reg Anesth Pain Med. 2006;31:237–47

3. Straube S, Derry S, Moore RA, Wiffen PJ, McQuay HJ. Single dose oral gabapentin for established acute postoperative pain in adults. Cochrane Database Syst Rev. 2010;CD008183

4. Chaparro LE, Smith SA, Moore A, Wiffen PJ, Gilron I. Pharmacotherapy for the prevention of chronic pain after surgery in adults. Cochrane Database syst Rev. 2013;CD008307.pub2

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