Reassessing Gabapentinoids for Chronic Neuropathic Pain after Adolescent Idiopathic Scoliosis Surgery—A Systematic Review

Abstract Gabapentinoids are well known for neuropathic pain management. Pre-emptive use in certain spinal procedures suggests their potential role in reducing post-surgery chronic neuropathic pain. However, its efficacy in adolescent idiopathic scoliosis (AIS) remains uncertain. This review aimed to evaluate the effectiveness of gabapentinoids in reducing neuropathic chronic postsurgical pain (CPSP) at ≥3 months as the primary outcome and on cumulative opioid consumption within the first 72 hours post-surgery as the secondary outcome. Major electronic databases, including PubMed, MEDLINE, Embase, Google Scholar, and the Cochrane Library, were screened until February 2025 for RCTs with patients aged ≤21 years who received gabapentin/pregabalin with a follow-up of at least 4 weeks after registering the protocol in PROSPERO (CRD420251112304). Data were synthesized using the Review Manager 5.4 software, employing the generic inverse variance method and random model. Four RCTs (n = 221) were included. Pre-emptive gabapentinoids showed no significant reduction in chronic neuropathic pain compared with placebo (risk ratio RR: 0.90; 95% CI: 0.45–1.78; I2 = 0%). Opioid consumption in the first 72 hours was modestly reduced (mean difference MD: −0.42; 95% CI: −0.64 to −0.20; I2 = 7%). Reported adverse events were generally mild, including sedation, dizziness, and nausea, with no serious respiratory complications. The evidence was very low due to small sample size, heterogeneity in drug type/dose/regimen, and indirectness of long-term pain outcomes. Pre-emptive gabapentinoids, including gabapentin and pregabalin, do not consistently prevent chronic neuropathic pain in adolescents after posterior spinal fusion and provide only limited short-term opioid-sparing benefit.