Gabapentinoids for Upper Airway Surgery Pain Management: Systematic Review and Meta-Analysis

Assess the analgesic and potential adverse effects of gabapentinoids in patients undergoing upper airway surgery (UAS).

A systematic review and meta-analysis was conducted following PRISMA guidelines. Data sources included Ovid Medline, Embase, Scopus, and Cochrane. All RCTs and cohort studies from June 2002 to August 2024 regarding treatment outcomes of gabapentinoids for UAS were extracted. Studies were subjected to a two-reviewer blinded screening, extraction, and appraisal process. Assessment of study quality was implemented via the NIH quality assessment tool for RCTs. Primary outcome was decreased postoperative pain. Secondary outcomes included adverse drug events and opiate needs postoperatively.

Out of 397 studies screened, 21 met inclusion criteria. There were 828 gabapentinoid patients and 684 controls. Twelve studies were adenotonsillectomies and tonsillectomies, six were septoplasties, one was septoplasty with and without turbinoplasty, one lateral pharyngoplasty and tonsillectomy, and one maxillomandibular advancement. Appraisal revealed studies were of low (18) and moderate (3) risk of bias. Meta-analyses with subgroupings as appropriate were performed for these categories: pain score at 0-2 and 16-24 h; opioid consumption post-surgery; minutes to first analgesia; postoperative dizziness, nausea, and vomiting. Gabapentinoids significantly lowered pain levels 0-2 and 16-24 h postoperatively, decreased opioid consumption, and increased time to first analgesia.

This review of current scientific literature supports perioperative use of gabapentinoids for UAS to reduce postoperative pain and lower analgesic requirement. Future studies should include larger cohorts with standardized protocols regarding timing, dosing of medication, objective measurements, proper blinding procedures for study personnel, and robust statistical analysis.