Effectiveness of gabapentinoids for postoperative pain management and opioid reduction after lumbar spine surgery: a systematic review and meta-analysis

Abstract

Background Lumbar spine surgery is commonly associated with moderate to severe postoperative pain, often requiring opioid analgesics. Gabapentinoids are widely incorporated into multimodal analgesic regimens; however, their effectiveness in this setting remains uncertain. Methods This systematic review and meta-analysis of randomized controlled trials was conducted according to the PRISMA 2020 guidelines. PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar were searched from database inception to February 2026. Eligible studies compared gabapentinoids with placebo or standard care in adults undergoing lumbar spine surgery. Primary outcomes were postoperative pain scores and opioid consumption within 24 hours. Risk of bias was assessed using the Cochrane RoB 2 tool. Pooled estimates were calculated using random-effects models and expressed as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Results Ten randomized controlled trials were included. Gabapentinoids significantly reduced pain scores at 24 hours (SMD = −0.74, 95% CI −0.97 to −0.51; I 2 = 0.0%) and during the early postoperative period (≤12 hours) (SMD = −0.91, 95% CI −1.15 to −0.68; I 2 = 26.7%). Opioid consumption within 24 hours was also reduced (SMD = −1.33, 95% CI −1.84 to −0.83; I 2 = 82.3%). Overall, the included studies had low risk of bias or some concerns. Conclusions Gabapentinoids were associated with reduced postoperative pain and opioid consumption following lumbar spine surgery, supporting their role as an adjunct to multimodal perioperative analgesia. Further high-quality randomized trials are needed to determine optimal dosing strategies and better characterize their safety profile.