1445 - Efficacy and Safety of Perioperative Gabapentinoid Use in Older Adults Undergoing Non-Spine Neurosurgical Procedures: A Meta Analysis with Emphasis on Delirium, Functional Recovery, and Long-Term Cognitive Outcomes

Objectives: Evaluating the effectiveness and safety of perioperative gabapentinoid usage in adults aged 65 and older undergoing non-spinal procedures. Delirium, functional recovery, and long-term cognitive focus will be assessed.

Design: Randomized controlled trials and cohort studies that focus on perioperative gabapentin or pregabalin use in this population were included. Eligible studies include patients aged ≥ 65, non-spinal neurosurgical procedures, and reporting of at least one primary outcome. Primary outcomes in the study include delirium, functional recovery, and long-term cognitive effects; secondary outcomes include pain control, opioid addiction, and adverse events. Exclusion criteria included studies limited to spinal procedures, use of gabapentin or pregabalin for pre-existing conditions, and studies with fewer than 10 patients. Cochrane methods are used for data extraction and assessing the risk of bias. Random effects meta-analysis is used to account for study heterogeneity.

Results: Meta-analysis shows the perioperative gabapentinoid use in older adults is associated with a minimal decline in postoperative opioid consumption but no reduction in pain scores. The rate of delirium is associated with a dose-dependent increase of gabapentinoids in this population, with an adjusted odds ratio of 1.43 (95% CI, 1.28-1.60). In patients with chronic kidney disease, increased risks of delirium, cognitive dysfunction, and functional recovery were found.

Conclusions: The use of gabapentinoids in this population is not supported due to increased risk of adverse events. There is a limited benefit of decreased postoperative opioid consumption. Individualized risk-benefit analysis is recommended in this population. Further research is urgent to establish the most effective and safest pain management strategies within this population.