Three high quality studies evaluated the difference in dosing of gabapentinoids and their effects on postoperative pain, opioid consumption, and complications after primary TJA.
One study directly compared 75 mg of pregabalin twice a day for 6 weeks compared to 150 mg of pregabalin twice a day for 6 weeks postoperatively.
The strength of recommendation is moderate given there is only one high quality study comparing high- and low-dose pregabalin, and studies comparing gabapentin to placebo found no difference in postoperative pain and opioid consumption with a lack of consistency in measures/scales for these high priority outcomes. It is the opinion of the workgroup that gabapentinoids be used cautiously especially when given concurrently with opioids or used in the elderly given pregabalin is associated with increased risk of postoperative sedation. Recent publications by the Food and Drug Administration (FDA) and other surgical subspecialties have highlighted these concerns regarding respiratory depression with concurrent use of opioids and gabapentinoids.
- Petersen K, Lunn T, Husted H, Hansen L, Simonsen O, Laursen M, et al. The influence of pre- and perioperative administration of gabapentin on pain 3–4 years after total knee arthroplasty. Scand J Pain 2018;18:237–45. doi:10.1515/sjpain-2018-0027
- Lunn T, Husted H, Laursen M, Hansen L, Kehlet H. Analgesic and sedative effects of perioperative gabapentin in total knee arthroplasty. Pain 2015;156:2438–48. doi:10.1097/j.pain.0000000000000309 .
- Singla N, Chelly J, Lionberger D, Gimbel J, Sanin L, Sporn J, et al. Pregabalin for the treatment of postoperative pain: results from three controlled trials using different surgical models. J Pain Res 2014;Volume 8:9–20. doi:10.2147/jpr.s67841 .