Enhanced recovery after pancreaticoduodenectomy: Systematic review and meta-analysis

Pregabalin has been used as an adjuvant in some trials to control postoperative pain after gynecologic surgery. However, the potential clinical advantage remains debatable.We performed a meta-analysis of clinical trials of pregabalin to evaluate its ability to control acute postoperative pain after gynecologic surgery.We searched PubMed, ScienceDiret, and the Cochrane Library of Randomized Controlled Trials up to January 2014. We performed a systematic review and meta-analysis of prospective controlled studies reporting pregabalin for gynecologic surgery. The primary outcome was pain outcomes and postoperative cumulative opioid consumption. Data were reported as weighted mean differences (WMDs) and 95% CIs. The secondary outcome was adverse effects after surgery.Six valid randomized trials met the eligibility criteria and were included in the meta-analysis. Pooled data were collected from 452 patients between 2007 and 2012 (These trials were separately conducted in Greece 2012, India 2011–2012, Turkey 2011, Denmark 2009 and Australia 2007). The pregabalin-treated patients consumed fewer opioids during the first 24 hours postoperatively (WMD, −8.50 mg; 95% CI, −11.29 to −5.71 mg; P < 0.00001). Pain intensity at rest and on movement or coughing revealed a statistically significant pain relief effect of pregabalin during 24 hours postoperatively (at rest: WMD, −6.20 mm; 95% CI, −11.83 to −0.58 mm; P = 0.03; on movement or coughing: WMD, −5.32 mm; 95% CI, −9.73 to −0.91 mm; P = 0.02). No differences were found between the pregabalin and control groups for the adverse effects.Pregabalin has an analgesic and opioid-sparing effect and does not increase the frequency of adverse effects in acute postoperative pain management after gynecologic surgery.