Does gabapentin add value to multimodal analgesia in thoracic surgery? A procedure-specific meta-analysis.

Aims: Thoracic surgery is associated with severe acute and chronic pain, high opioid use, and other adverse outcomes. Gabapentin is commonly used perioperatively, but its effectiveness remains uncertain. This systematic review and meta-analysis evaluated the efficacy and safety of perioperative gabapentin versus placebo after thoracic surgery. Patients and methods: Cochrane, Embase, PubMed, and Web of Science were searched through 29 August 2025 for randomized controlled trials comparing gabapentin with placebo in adults undergoing thoracic surgery. The primary outcome was pain at 24 hours. Secondary outcomes included pain at other time points, opioid consumption, chronic pain, and adverse events. Data were pooled using random-effects models. Results and conclusions: Six trials including 748 patients were analyzed. Gabapentin had no significant effect on rest pain at 24 hours (MD −0.13; 95% CI −1.17 to 0.91). A non-significant trend toward worse cough-evoked pain at 24 hours was observed with gabapentin (MD 0.53; 95% CI 0.00 to 1.07). Gabapentin also did not significantly affect opioid consumption, pain chronification, or adverse events such as nausea, sedation, or delirium. Based on low-certainty evidence, perioperative gabapentin does not appear to provide meaningful benefit after thoracic surgery. Protocol registration: The www.crd.york.ac.uk/prospero identifier is CRD420251136259.