Perioperative Gabapentin After Benign Anorectal Surgery: Statistically Significant but Clinically Uncertain? A...

Area of Science:

• Anesthesiology
• Surgical Pain Management
• Pharmacology

Background:

• Postoperative pain is a significant issue after anorectal surgery.
• It leads to longer hospital stays and increased opioid consumption.
• The efficacy of gabapentin in this context is not well-established.

Purpose of the Study:

• To systematically evaluate the effectiveness of preoperative gabapentin for managing pain after anorectal surgery.
• To synthesize evidence from randomized controlled trials and observational studies.

Main Methods:

• A systematic literature search was conducted across PubMed, Scopus, and Cochrane Library up to May 2025.
• Included studies compared preoperative gabapentin with placebo or standard care in patients undergoing anorectal surgery.
• Primary outcome was 24-hour postoperative pain assessed by Visual Analogue Scale (VAS); meta-analysis (random-effects and Bayesian) was performed.

Main Results:

• Six studies with 504 patients were included (242 gabapentin, 262 control).
• Gabapentin significantly reduced 24-hour VAS pain scores (MD = -2.10 cm; P=0.029).
• Bayesian analysis showed a 99.8% probability of benefit, but high heterogeneity (I²=99.2%) was noted.

Conclusions:

• Gabapentin demonstrates a statistically significant reduction in postoperative pain following anorectal surgery.
• However, the evidence is of very low certainty and highly heterogeneous.
• Clinical relevance is uncertain, and routine use is not recommended at this time.