Richard Wang, Avrohom Karp, Kevin Clare, Bridget Nolan, Eris Spirollari, Sabrina Zeller, Ilya Frid, Chirag D Gandhi, Merritt Kinon, Rachana Tyagi, John V Wainwright
{"title":"加巴喷丁类药物在脊柱外科ERAS方案中的应用：一项系统综述和荟萃分析。","authors":"Richard Wang, Avrohom Karp, Kevin Clare, Bridget Nolan, Eris Spirollari, Sabrina Zeller, Ilya Frid, Chirag D Gandhi, Merritt Kinon, Rachana Tyagi, John V Wainwright","doi":"10.1097/BSD.0000000000001877","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>Systematic review and meta-analysis.</p><p><strong>Objective: </strong>This study aimed to estimate the safety and efficacy of gabapentinoid usage in ERAS protocols for spine surgery through a systematic review and meta-analysis.</p><p><strong>Summary of background data: </strong>Enhanced Recovery after Surgery (ERAS) is a perioperative strategy designed to improve surgical outcomes through multimodal protocols. These protocols often utilize gabapentinoids to reduce postoperative opioid usage while controlling patient pain. However, recent studies have implicated gabapentinoids in complications and even the death of patients when used in combination with opioids.</p><p><strong>Methods: </strong>The PubMed database was searched using 2 MeSH terms. An initial query aimed to identify studies that utilized ERAS spine protocols that include gabapentinoids. A secondary query targeted studies specifically investigating gabapentinoid complications in spine surgery and examined gabapentinoid side effects.</p><p><strong>Results: </strong>Three thousand forty-five patients were included in the selected ERAS comparison studies, and 417 patients were analyzed in the selected gabapentinoid-specific side effect comparison studies. Ten cohort studies were identified in the ERAS query. A meta-analysis of proportions revealed a decrease in the LOS for the ERAS cohorts compared with traditional treatment groups (P<0.05). No significant differences were found for the other measures. The second query identified thirteen RCTs for pregabalin and nine for gabapentin. Meta-analysis of proportions for complications at different dosages of pregabalin and gabapentin revealed a significant reduction in nausea and vomiting with 150 mg pregabalin as compared with control (P<0.05). No other significant differences in side effects were found with other doses of pregabalin or gabapentin as compared with placebo.</p><p><strong>Conclusions: </strong>ERAS spine surgery protocols, including gabapentinoids, may reduce hospital lengths of stay, with gabapentinoid analgesia having comparable or improved side effect profiles compared with placebo. Although adverse events involving the combination of gabapentinoids and opioids have been reported, these outcomes were not described in the literature examined for spine surgery.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Gabapentinoids in ERAS Protocols For Spine Surgery: A Systematic Review and Meta-Analysis.\",\"authors\":\"Richard Wang, Avrohom Karp, Kevin Clare, Bridget Nolan, Eris Spirollari, Sabrina Zeller, Ilya Frid, Chirag D Gandhi, Merritt Kinon, Rachana Tyagi, John V Wainwright\",\"doi\":\"10.1097/BSD.0000000000001877\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study design: </strong>Systematic review and meta-analysis.</p><p><strong>Objective: </strong>This study aimed to estimate the safety and efficacy of gabapentinoid usage in ERAS protocols for spine surgery through a systematic review and meta-analysis.</p><p><strong>Summary of background data: </strong>Enhanced Recovery after Surgery (ERAS) is a perioperative strategy designed to improve surgical outcomes through multimodal protocols. These protocols often utilize gabapentinoids to reduce postoperative opioid usage while controlling patient pain. However, recent studies have implicated gabapentinoids in complications and even the death of patients when used in combination with opioids.</p><p><strong>Methods: </strong>The PubMed database was searched using 2 MeSH terms. An initial query aimed to identify studies that utilized ERAS spine protocols that include gabapentinoids. A secondary query targeted studies specifically investigating gabapentinoid complications in spine surgery and examined gabapentinoid side effects.</p><p><strong>Results: </strong>Three thousand forty-five patients were included in the selected ERAS comparison studies, and 417 patients were analyzed in the selected gabapentinoid-specific side effect comparison studies. Ten cohort studies were identified in the ERAS query. A meta-analysis of proportions revealed a decrease in the LOS for the ERAS cohorts compared with traditional treatment groups (P<0.05). No significant differences were found for the other measures. The second query identified thirteen RCTs for pregabalin and nine for gabapentin. Meta-analysis of proportions for complications at different dosages of pregabalin and gabapentin revealed a significant reduction in nausea and vomiting with 150 mg pregabalin as compared with control (P<0.05). No other significant differences in side effects were found with other doses of pregabalin or gabapentin as compared with placebo.</p><p><strong>Conclusions: </strong>ERAS spine surgery protocols, including gabapentinoids, may reduce hospital lengths of stay, with gabapentinoid analgesia having comparable or improved side effect profiles compared with placebo. 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引用次数: 0
摘要
研究设计：系统评价和荟萃分析。目的：本研究旨在通过系统回顾和荟萃分析来评估加巴喷丁类在脊柱外科ERAS方案中使用的安全性和有效性。背景资料总结：ERAS （Enhanced Recovery after Surgery）是一种围手术期策略，旨在通过多模式协议改善手术效果。这些方案通常使用加巴喷丁类药物来减少术后阿片类药物的使用，同时控制患者的疼痛。然而，最近的研究表明，加巴喷丁类药物与阿片类药物联合使用会导致并发症甚至患者死亡。方法：采用2个MeSH检索词检索PubMed数据库。最初的查询旨在确定使用ERAS脊柱方案的研究，其中包括加巴喷丁类。第二项研究专门调查了加巴喷丁类药物在脊柱手术中的并发症，并检查了加巴喷丁类药物的副作用。结果：入选ERAS比较研究纳入345例患者，入选加巴喷丁类药物特异性副作用比较研究纳入417例患者。在ERAS查询中确定了10个队列研究。一项比例荟萃分析显示，与传统治疗组相比，ERAS队列的LOS减少(pp结论：ERAS脊柱手术方案，包括加巴喷丁类药物，可能缩短住院时间，与安慰剂相比，加巴喷丁类止痛药具有相当或改善的副作用。虽然加巴喷丁类药物和阿片类药物联合使用的不良事件有报道，但这些结果在脊柱外科文献中没有描述。
Gabapentinoids in ERAS Protocols For Spine Surgery: A Systematic Review and Meta-Analysis.
Study design: Systematic review and meta-analysis.
Objective: This study aimed to estimate the safety and efficacy of gabapentinoid usage in ERAS protocols for spine surgery through a systematic review and meta-analysis.
Summary of background data: Enhanced Recovery after Surgery (ERAS) is a perioperative strategy designed to improve surgical outcomes through multimodal protocols. These protocols often utilize gabapentinoids to reduce postoperative opioid usage while controlling patient pain. However, recent studies have implicated gabapentinoids in complications and even the death of patients when used in combination with opioids.
Methods: The PubMed database was searched using 2 MeSH terms. An initial query aimed to identify studies that utilized ERAS spine protocols that include gabapentinoids. A secondary query targeted studies specifically investigating gabapentinoid complications in spine surgery and examined gabapentinoid side effects.
Results: Three thousand forty-five patients were included in the selected ERAS comparison studies, and 417 patients were analyzed in the selected gabapentinoid-specific side effect comparison studies. Ten cohort studies were identified in the ERAS query. A meta-analysis of proportions revealed a decrease in the LOS for the ERAS cohorts compared with traditional treatment groups (P<0.05). No significant differences were found for the other measures. The second query identified thirteen RCTs for pregabalin and nine for gabapentin. Meta-analysis of proportions for complications at different dosages of pregabalin and gabapentin revealed a significant reduction in nausea and vomiting with 150 mg pregabalin as compared with control (P<0.05). No other significant differences in side effects were found with other doses of pregabalin or gabapentin as compared with placebo.
Conclusions: ERAS spine surgery protocols, including gabapentinoids, may reduce hospital lengths of stay, with gabapentinoid analgesia having comparable or improved side effect profiles compared with placebo. Although adverse events involving the combination of gabapentinoids and opioids have been reported, these outcomes were not described in the literature examined for spine surgery.
期刊介绍：
Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure.
Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.
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