Gabapentinoid Use Following Discharge
Pregabalin after discharge reduces postoperative pain, neuropathic pain, and opioid consumption after primary TJA, but gabapentin does not reduce pain or 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

Six high quality studies evaluated the efficacy of post-discharge gabapentinoids on pain and opioid consumption after TJA.[2–4,7,9,13] Three of these studies evaluated gabapentin prescribed for 4 - 7 days after TKA. One study evaluated two weeks of pregabalin after TKA, one study evaluated 6 weeks of pregabalin after TKA, and one study evaluated one week of pregabalin after THA. Due to heterogeneity of outcomes reported, no meta-analyses were completed.

Qualitative review of the three studies that evaluated treatment with gabapentin for less than 7 days after TKA found that it had no impact on postoperative pain in all three studies.[4,7,9] One of these studies evaluated chronic and neuropathic pain at 3 – 4 years postoperatively and found no effect of gabapentin compared to placebo.[7] Only one study evaluated opioid consumption after discharge and found there was no difference in opioid consumption at 6 days postoperatively between gabapentin and placebo.[9]

              There were two pregabalin studies that evaluated pain scores between 3 days and 1 week postoperatively and one that evaluated pain scores at 3 months and 6 months postoperatively. All three of these studies found favorable reductions in pain scores with pregabalin compared to placebo.[2,3,14] Two of these studies evaluated opioid consumption after discharge.[2,3] Buvanendran et al. found no difference in opioid use at 6 months postoperatively between patients who received pregabalin and placebo. However, they did find that rates of neuropathic pain were lower in patients who received pregabalin compared to placebo. [2] Clarke et al. found at 1 week postoperatively patients who received pregabalin consumed fewer opioids than patients who received placebo.[3]


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