The Role of Antiepileptics for Postoperative Pain Management

Junyong In, Kevin Huynh, Jennifer Luong, Dillon Sooknanan, Sakura Kinjo

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review

Abstract

Antiepileptic drugs provide an analgesic effect and have been used to treat chronic pain for decades. During the past twenty years, some of these medications have been used in perioperative settings, as part of a multimodal pain regimen. In this context, the most commonly used and studied drugs are gabapentinoids, such as gabapentin and pregabalin. In contrast to the results of multiple RCTs in the past, a recent well-regarded systematic review and meta-analysis including 281 trials (N=24,682), published in 2020, reported that gabapentin and pregabalin provided no clinically meaningful analgesic efficacy in treating acute postoperative pain. This study also reported that they did not significantly reduce postoperative chronic pain but did contribute to a greater risk of adverse events such as dizziness and visual disturbance. Therefore, these authors concluded that routine use of gabapentin or pregabalin is not recommended for postoperative pain management. This study aggregated results across different types of surgeries. Other studies however have studied the risks and benefits of using gabapentinoids as part of a pain regimen for specific types of surgeries. Results from these studies indicate a reduction in postoperative pain for certain types of surgeries but not others. Results of pain studies for specific surgeries will be summarized in this chapter. Other Antiepileptic drugs such as carbamazepine, phenytoin, lamotrigine, lacosamide, zonisamide, and GABA-acting anticonvulsants (tiagabine, vigabatrin, felbamate) have not been commonly used for acute postoperative pain. Due to limited data, it is difficult to make any definitive conclusions regarding their effectiveness in perioperative settings.

Original languageEnglish
Title of host publicationPerioperative Pain Management
Subtitle of host publicationA Clinical Guide
PublisherSpringer Nature
Pages575-598
Number of pages24
ISBN (Electronic)9783031676482
ISBN (Print)9783031676475
DOIs
StatePublished - 1 Jan 2024

Keywords

  • Antiepileptic drug
  • Carbamazepine
  • GABA-acting anticonvulsants
  • Gabapentinoids
  • Lacosamide
  • Lamotrigine
  • Phenytoin
  • Zonisamide

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