Gabapentinoids and Postoperative Pain and/or Opioid Use
In the perioperative period after primary TJA, gabapentinoids do not reduce postoperative pain, but pregabalin reduces opioid consumption.
Anesthesia and Analgesia in Total Joint Arthroplasty
Developed by: American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, The Hip Society, and The Knee Society

Rationale

We reviewed thirteen high quality prospective randomized controlled trials that represented the best available evidence to assess the efficacy of gabapentinoids in reducing postoperative pain and opioid consumption after TJA.[2–14] Among the included studies, seven studies investigated gabapentin compared to placebo and six studies investigated pregabalin compared to placebo.[2–14] Despite these high quality studies, only a limited amount of meta-analyses were performed due to inconsistency in outcomes reported and the timepoints at which these outcomes were reported.  

            Gabapentin did not have any impact on postoperative pain in the perioperative period at all time points after TJA compared to placebo in the seven high quality studies included. Five studies specifically evaluated pain scores within 3 days postoperatively and found there was no difference in pain scores between patients treated with gabapentin and patients treated with placebo.[4–6,9,12] Of the five studies reporting opioid consumption, one study reported gabapentin reduced opioid consumption compared to placebo, while the other 4 studies found no difference.[4,5,9,11,12] Two of these studies were able to be included in a direct meta-analysis with limited heterogeneity, which determined gabapentin had no impact on morphine consumption measured at 72 hours postoperatively compared to placebo.[11,12] Direct meta-analyses evaluating complications associated with gabapentin compared to placebo found there was no difference in rates of nausea, vomiting, pruritus, dizziness, and sedation. 

            Pregabalin reduced opioid consumption, but did not show a consistently significant impact on postoperative pain compared to placebo in the perioperative period after primary TJA. Of the six studies included, five studies evaluated pain scores within 3 days postoperatively. Three of these studies found no difference in pain scores between placebo and pregabalin, while two studies found pregabalin reduced pain compared to placebo.[3,8,10,13,14] One study that demonstrated a favorable reduction in pain scores evaluated pregabalin for treatment of pain after total hip arthroplasty (THA) while the other study evaluated total knee arthroplasty (TKA) patients.  Due to heterogeneity of the pain scores reported and the timepoints at which the pain scores were reported a direct meta-analysis was not able to be completed. However, a direct meta-analysis of four studies evaluating the efficacy of pregabalin on opioid consumption found that pregabalin moderately reduces opioid consumption compared to placebo after TJA.[3,8,10,13] Direct meta-analyses were performed to evaluate complications associated with pregabalin compared to placebo. There were no differences between pregabalin and placebo in rates of vomiting, pruritus, and dizziness. However, a direct meta-analysis of three studies evaluating sedation found that pregabalin moderately increases the risk of sedation compared to placebo after TJA. A direct meta-analysis of four studies evaluating nausea after TJA found pregabalin reduces the incidence of nausea compared to placebo. 


LEARN MORE ABOUT AAOS

The Future of OrthoGuidelines

FIND OUT MORE

The OrthoGuidelines Process