Background:Optimal pain treatment with minimal side effects is essential for early mobility and recovery in patients undergoing total knee arthroplasty (TKA). We investigated the effect of pregabalin as an adjuvant for postoperative analgesia provided by opioid-based patient-controlled epidural analgesia (PCEA) in such patients.Materials and Methods:Forty patients undergoing unilateral primary TKA were randomly assigned to two equal groups, to receive either placebo or pregabalin 75 mg twice a day. The drug was administered orally starting before surgery and was continued for 2 days after surgery. Anesthetic technique was standardized. Postoperatively, static and dynamic pain was assessed by verbal rating score. Mean morphine consumption, PCEA usage, rescue analgesic requirement, and overall patient satisfaction were also assessed. Treatment emergent adverse drug reactions were recorded.Results:Mean morphine consumption was significantly reduced by pregabalin. Postoperative pain (both static and dynamic) and PCEA consumption too was significantly reduced in the pregabalin group during the first 48 h after surgery. This group needed fewer rescue analgesics and recorded higher overall patient satisfaction. Pregabalin-treated patients had fewer opioid-related adverse reactions like nausea, vomiting, and constipation. Dizziness was noted in two of the patients receiving pregabalin. There was no statically significant difference in the incidence of sedation in the two groups.Conclusions:Oral pregabalin 75 mg started preoperatively is a useful adjunct to epidural analgesia following TKA. It reduces opioid consumption, improves postoperative analgesia, and yields higher patient satisfaction levels.