The Role of Antiepileptics for Postoperative Pain Management

Antiepileptic drugsAntiepileptic drug provide an analgesicAnalgesics effect and have been used to treat chronic painChronic pain for decades. During the past twenty years, some of these medications have been used in perioperativePerioperative settings, as part of a multimodal pain regimen. In this context, the most commonly used and studied drugs are gabapentinoidsGabapentinoids, 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 analgesicAnalgesics efficacy in treating acute postoperative painPostoperative pain. This study also reported that they did not significantly reduce postoperative chronic painChronic pain but did contribute to a greater riskRisks 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 managementPostoperative pain management. This study aggregated results across different types of surgeries. Other studies however have studied the risksRisks and benefits of using gabapentinoidsGabapentinoids as part of a pain regimen for specific types of surgeries. Results from these studies indicate a reduction in postoperative painPostoperative pain for certain types of surgeries but not others. Results of pain studies for specific surgeries will be summarized in this chapter. Other Antiepileptic drugsAntiepileptic drug such as carbamazepineCarbamazepine, phenytoinPhenytoin, lamotrigineLamotrigine, lacosamideLacosamide, zonisamideZonisamide, and GABA-acting anticonvulsantsGABA-acting anticonvulsants (tiagabine, vigabatrin, felbamate) have not been commonly used for acute postoperative painPostoperative pain. Due to limited data, it is difficult to make any definitive conclusions regarding their effectiveness in perioperativePerioperative settings.