Perioperative Gabapentin After Benign Anorectal Surgery: Statistically Significant but Clinically Uncertain? A Systematic Review and Meta-Analysis

Background Postoperative pain remains a major concern after anorectal surgery, contributing to delayed discharge and increased opioid use. Although perioperative gabapentin has been evaluated in multiple surgical settings, its clinical value in anorectal surgery remains uncertain. Methods A systematic search of PubMed, Scopus, and the Cochrane Central Register of Controlled Trials identified studies published through May 2025. Randomized clinical trials and observational cohorts comparing preoperative gabapentin with placebo or standard analgesia in patients undergoing anorectal surgery were included. The primary outcome was 24-hour postoperative pain measured on the Visual Analogue Scale (VAS). Mean differences (MDs) were pooled using a random-effects model with 95% confidence intervals (CIs), and heterogeneity was quantified using the I 2 statistic. To assess robustness and clinical probability, a complementary Bayesian random-effects meta-analysis was performed. Analyses were conducted in R (version 4.4.2). Results 6 studies, including 504 patients (242 gabapentin and 262 control), were included. Among these, postoperative pain at 24 hours (VAS) was available in four studies comprising 415 patients. Pooled results demonstrated significantly lower 24-hour VAS scores with gabapentin (MD = −2.10 cm; 95% CI −3.98 to −0.22; P = 0.029; I 2 = 99.2%). The Bayesian model favored gabapentin, with a posterior probability of benefit of 99.8%. Conclusion Gabapentin shows a statistically detectable reduction in postoperative pain after anorectal surgery, but the effect is heterogeneous and supported by very low certainty evidence, making its clinical relevance uncertain and limiting its role in routine practice.