Perioperative Use of Gabapentinoids: Comment

It was a pleasure to read the article from Verret et al. in recent issue of Anesthesiology.1 The main prerequisites high-quality systematic review were met; however, some considerations about patient, intervention, comparison, and study design approach applied conclusion must be addressed. outcomes meta-analysis pooled results highly divergent procedures, endoscopic procedures major surgeries. A relevant both Enhanced Recovery after Surgery Perioperative Surgical Home doctrines is specificity surgical route standardization.2,3 possibility another analgesic regiment being used comparator group concern. use gabapentin compared with antidepressants, opioids, ketamine, nonsteroidal anti-inflammatory drugs, corticosteroids, benzodiazepines, neuroleptics, anticonvulsant, α2-adrenergic receptor agonists, paracetamol, melatonin, placebo. each these agents incites completely different conclusions, and—with exception placebo—would not give any idea effectiveness studied intervention when pooled.Beyond clinical heterogeneity, statistical heterogeneity also issue. inconsistency (I2) over 75% (considerable according Cochrane Handbook for Systematic Reviews Interventions) found every acute subacute pain summary measure confirms previous considerations.4 Its high level considered prohibitive feature considering performing many protocols raises concerns conclusions announced by authors. That dictate how are understood reflects aforementioned heterogeneity.The inclusion unequal populations comparison groups increased precision estimates, while it reduced applicability results. low certainty evidence rated primary implies that true effect probably markedly estimated effect.5 assumption further research unlikely change gabapentinoids early postoperative analgesia consistent trial’s sequential analysis, but does contemplate between included studies.The author declares no competing interests.