Analgesic and sedative effects of perioperative gabapentin in total knee arthroplasty

Abstract

Gabapentin has shown acute postoperative analgesic effects, but the optimal dose and procedure-specific benefits vs harm have not been clarified. In this randomized, double-blind, placebo-controlled dose-finding study, 300 opioid-naive patients scheduled for total knee arthroplasty were randomized (1:1:1) to either gabapentin 1300 mg/d (group A), gabapentin 900 mg/d (group B), or placebo (group C) daily from 2 hours preoperatively to postoperative day 6 in addition to a standardized multimodal analgesic regime. The primary outcome was pain upon ambulation 24 hours after surgery, and the secondary outcome was sedation 6 hours after surgery. Other outcomes were overall pain during well-defined mobilizations and at rest and sedation during the first 48 hours and from days 2-6, morphine use, anxiety, depression, sleep quality, and nausea, vomiting, dizziness, concentration difficulty, headache, visual disturbances, and adverse reactions. Pain upon ambulation (visual analog scale, mean [95% confidence interval]) 24 hours after surgery in group A vs B vs C was as follows: 41 [37-46] vs 41 [36-45] vs 42 [37-47], P = 0.93. Sedation (numeric rating scale, median [range]) 6 hours after surgery was as follows: 3.2 [0-10] vs 2.6 [0-9] vs 2.3 [0-9], the mean difference A vs C being 0.9 [0.2-1.7], P = 0.046. No between-group differences were observed in overall pain or morphine use the first 48 hours and from days 2-6. Sleep quality was better during the first 2 nights in group A and B vs C. Dizziness was more pronounced from days 2-6 in A vs C. More severe adverse reactions were observed in group A vs B and C. In conclusion, gabapentin may have a limited if any role in acute postoperative pain management of opioid-naive patients undergoing total knee arthroplasty and should not be recommended as a standard of care.

Postoperative pain treatment after total knee arthroplasty: A systematic review

“…One study reported an accumulation of undesirable reactions due to the study drug in the intervention groups; lapse of memory function, impaired balance, hypotension, diplopia, sedation, dizziness and fatigue [85]. …”

Correlations between inflammatory cytokines, muscle damage markers and acute postoperative pain following primary total knee arthroplasty

“…The management of acute postoperative pain, however, is still far from optimal, and TKA is among the most painful surgeries [19, 36]. In this study, we quantitatively assessed the possible correlations between inflammatory cytokines, muscle damage markers and acute postoperative pain, which few studies have reported, in 96 consecutive primary TKA patients.…”

Anesthesia for the patient undergoing total knee replacement: current status and future prospects

“…A randomized, double-blind study, examining the analgesic and sedative effects of perioperative gabapentin, concluded that there was no improvement in pain control upon ambulation after 24 hours in the gabapentin group. They also noted an increase in sedation at 6 hours postoperatively with gabapentin at a dose of 1,300 mg/d relative to placebo 42. In contrast to the previous studies, there are also studies showing benefits to perioperative gabapentinoids.…”