With the increasing popularity of enhanced recovery protocols and the growing opioid epidemic, recent pain management pathways have emphasized opioid-sparing measures. As a result, gabapentinoids are being used following surgery and have become one of the most common opioid-sparing analgesics prescribed. However, they are not without risk, with several cases of respiratory depression and oversedation being reported.

This systematic review and meta-analysis aimed to evaluate the impact of gabapentinoids on sedative complications following abdominal surgery in order to guide future clinical decisions. The Pubmed and Embase databases were searched according to PRISMA guidelines to identify randomized controlled trials comparing gabapentinoids with placebo following abdominal surgery with respect to sedation complications. The Cochrane Risk of Bias Tool was used to assess study quality. A comparative meta-analysis was performed on the data.

Of the 3,988 studies retrieved, 19 were eligible for meta-analysis. Eleven of the 19 studies assessed pregabalin (100 to 1,200 mg) and eight assessed gabapentin (300 to 1,200 mg). Postoperative sedation scores were higher in the gabapentinoid group (p<0.01) relative to placebo. Subgroup analyses demonstrated higher scores two hours after surgery for gabapentinoids (p=0.03), but no statistical difference at 24 hours (p=0.19). Different doses did not yield any differences on forest plot analyses.

Respiratory depression rates were higher in the gabapentinoid group, compared with placebo (p=0.02).

The preoperative use of gabapentinoids is associated with sedative complications, including respiratory depression. These results may help guide future perioperative pain protocols.