The Role of Gabapentin in Enhanced Recovery After Surgery (ERAS) for Patients Undergoing Abdominal Procedures, A Systematic Review and Meta-Analysis

Background and Aims: Postoperative pain management remains a significant challenge for patients undergoing abdominal surgery, with poorly managed pain adversely affecting recovery, leading to increased opioid use and associated side effects. Gabapentin, an anticonvulsant, has been proposed as an effective analgesic within enhanced recovery after surgery (ERAS) protocols to minimize opioid consumption and reduce postoperative nausea and vomiting (PONV). However, its role in perioperative pain management lacks consensus, necessitating a systematic review and meta-analysis. Methods: A systematic review and meta-analysis of randomized controlled trials and observational studies were conducted, following PRISMA guidelines. Databases including PubMed, Scopus, and EMBASE were searched up to August 2024 using terms such as "gabapentin," "postoperative pain," and "ERAS." Studies involving gabapentin or pregabalin in abdominal surgery were included. Pain was assessed using the visual analog scale (VAS), opioid consumption was converted to morphine equivalents, and PONV rates were analyzed. Meta-analysis was performed using STATA 17 software with a random-effects model due to high clinical heterogeneity. Results: Twenty-two studies with 1812 patients (909 in the gabapentin group and 903 in the control group) were included. Gabapentin significantly reduced postoperative pain (Hedges's g = -1.65, 95% CI: -2.34 to -0.97, p < 0.001) and opioid consumption (Hedges's g = -2.25, 95% CI: -4.29 to -0.20, p = 0.03). Gabapentin also significantly reduced PONV (log OR = -0.67, 95% CI: -1.25 to -0.09, p = 0.02). Adverse effects were mild, including sedation and dizziness. Conclusion: Gabapentin demonstrates efficacy in reducing postoperative pain, opioid consumption, and PONV in patients undergoing abdominal surgery. Despite substantial heterogeneity across studies, the results suggest gabapentin as a valuable addition to ERAS protocols. Further research is necessary to optimize dosing strategies and address safety concerns, especially regarding sedation in vulnerable populations.