Gabapentin for Postoperative Analgesia in Cardiac Surgery via Sternotomy: A Systematic Review and Meta-Analysis of...

Opioids remain the mainstay for moderate-to-severe postoperative pain after cardiac surgery but are associated with frequent adverse effects. Gabapentin has been proposed as part of multimodal analgesia to reduce opioid use and related complications. However, existing evidence in cardiac surgery is limited and heterogeneous. This systematic review and meta-analysis aimed to evaluate the latest evidence on the efficacy and safety of perioperative gabapentin for postoperative analgesia in adults undergoing cardiac surgery.

PubMed, Embase, and the Cochrane Library were searched through October 1, 2025, for randomized controlled trials (RCTs) comparing perioperative gabapentin with placebo in adults undergoing cardiac surgery via sternotomy. The primary outcome was postoperative pain at 24 hours. Secondary outcomes included pain at other time points, opioid consumption, and adverse events (nausea, vomiting, sedation, atrial fibrillation). Pooled analyses used random-effects models with mean differences for pain outcomes, standardized mean differences for opioid consumption, and risk ratios for dichotomous outcomes, with 95% confidence intervals. The certainty of evidence across outcomes was assessed using the GRADE framework.

Six RCTs, including 751 patients, were analyzed. Mean age ranged from 50 to 69.9 years, and 82.9% were male. Gabapentin was not associated with a statistically significant reduction in rest pain (MD -0.69; 95% CI -1.38 to 0.00; p = 0.0507) or cough-elicited pain at 24 hours (MD -0.34; 95% CI -0.71 to 0.04; p = 0.079). However, a modest but statistically significant reduction in cough-elicited pain was observed at 6 hours (MD -1.24; 95% CI -2.45 to -0.03; p = 0.0439). Gabapentin was associated with lower opioid consumption at 24 hours when analyzed using standardized mean difference (SMD ‒1.06; 95% CI ‒2.02 to ‒0.11; p = 0.0295). No significant differences were observed for pain outcomes at other time points or for adverse events, including sedation, nausea, vomiting, or atrial fibrillation. According to the GRADE framework, the certainty of evidence for these outcomes ranged from low to very low.

Gabapentin provided a small, isolated reduction in early cough-elicited pain but not a clinically meaningful reduction in opioid consumption or overall analgesic benefit after cardiac surgery via sternotomy. Routine use as part of multimodal analgesia is not supported.