Efficacy of gabapentin and pregabalin for treatment of post refractive surgery pain: a systematic review and meta-analysis

Int Ophthalmol. 2024 Oct 24;44(1):409. doi: 10.1007/s10792-024-03300-9.

Abstract

Introduction: For ophthalmic patients, eye discomfort is a major problem that requires efficient pain treatment techniques. Pregabalin and gabapentin have surfaced as viable treatments for post-refractive surgery pain. To manage pain after refractive surgery, gabapentin and pregabalin were evaluated in this systematic review and meta-analysis.

Methodology: A thorough search of databases including PubMed, Embase, Cochrane Library, and CINAHL was performed until March 2024. Inclusion criteria were randomized controlled trials assessing pregabalin and/or gabapentin's effectiveness in treating pain post-PRK, LASIK, and LASEK surgeries.

Results: Six studies met inclusion criteria, comprising a total of 391 patients undergoing various corneal surgeries. The meta-analysis revealed that pregabalin was significantly more effective than placebo in reducing pain on the first and second postoperative days (SMD day 1: -0.32, 95% CI -0.54, -0.09; SMD day 2: -0.55, 95% CI -0.85, -0.25), while gabapentin showed significant pain reduction on the second day only (SMD day 2: -0.42, 95% CI -0.71, -0.13). Combined analysis for both medications showed significant pain reduction on the first- and second-days post-surgery. No significant increase in adverse events was associated with either medication. Publication bias was minimal except for a slight asymmetry noted on day 1 effectiveness.

Conclusion: Pregabalin and gabapentin are effective in reducing postoperative pain following refractive surgeries, with pregabalin showing a greater effect. Both medications are safe, with no significant increase in adverse events. Further research with standardized methodologies and long-term follow-up is recommended to optimize postoperative pain management in ocular surgeries.

Keywords: Gabapentin; Laser epithelial keratomileusis; Laser-assisted in situ keratomileusis; Meta-analysis; Pain control; Photo refractive keratectomy; Post refractive surgery; Pregabalin; Systematic review.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Analgesics* / therapeutic use
  • Eye Pain* / diagnosis
  • Eye Pain* / drug therapy
  • Eye Pain* / etiology
  • Gabapentin* / therapeutic use
  • Humans
  • Pain Measurement
  • Pain, Postoperative* / diagnosis
  • Pain, Postoperative* / drug therapy
  • Pain, Postoperative* / etiology
  • Pregabalin* / therapeutic use
  • Refractive Surgical Procedures* / adverse effects
  • Refractive Surgical Procedures* / methods
  • Treatment Outcome

Substances

  • Analgesics
  • Gabapentin
  • Pregabalin