Analgesic Efficacy of Gabapentin in Patients Undergoing Carpal Tunnel Release Surgery: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials.

Abstract

Carpal tunnel syndrome (CTS) results from median nerve compression and may lead to significant pain. Surgical management through release is the gold standard approach for severe CTS patients. Gabapentin is used as an analgesic drug, but data on its postoperative effects on pain assessment and safety measures are unclear. We aimed to assess the clinical effectiveness of gabapentin in patients undergoing CTS release surgery. We searched PubMed, Scopus, Web of Science (WOS), and the Cochrane Library for randomized controlled trials (RCTs) addressing the effectiveness of gabapentin in patients with CTS release until September 2024. The primary outcome was the assessment of postoperative pain at one, six, 12, and 24 hours by a visual analog scale (VAS). Other specific outcomes were adverse events. Data were pooled as effect sizes (mean difference (MD) or odds ratio (OR)) with their 95% confidence interval (CI) in a random-effects model using Stata/MP 18. Three RCTs comprising 205 patients were included in the pooled meta-analysis. Gabapentin significantly reduced postoperative pain at six, 12, and 24 hours compared to placebo (MD = -0.6, 95% CI: -0.63 to 0.57, p < 0.001; MD = -2.14, 95% CI: -2.18 to -2.1, p < 0.001; and MD = -1.41, 95% CI: -1.82 to -0.99, p < 0.001, respectively). On the other hand, no significant differences were observed regarding other studied outcomes (i.e., safety) between the two groups. This pooled meta-analysis of 205 patients revealed that gabapentin was associated with reduced pain postoperatively at 6, 12, and 24 hours with comparable rates of adverse events compared to placebo. Further RCTs are warranted to validate the current findings.