The efficacy of perioperative gabapentin for the treatment of postoperative pain following total knee and hip arthroplasty: a meta-analysis

Abstract

Background: Postoperative pain after total knee arthroplasty (TKA) and total hip arthroplasty (THA) influence patients' rehabilitation and life quality. Although gabapentin has been widely used for analgesia, its efficacy is still controversial in TKA and THA. This meta-analysis was performed to assess the efficacy and safety of gabapentin following TKA and THA. Method: Electronic databases including PubMed, EMBASE, Cochrane Central Register of Controlled Trials, MEDLINE, and ClinicalTrials.gov were comprehensively retrieved for randomized controlled trials from their inception to June 2019. A total of 7 studies, which compared the administration of gabapentin with that of placebo for the treatment of postoperative pain, were included in our meta-analysis. The meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Result: There was no difference in pain score at 24 (P = 0.87), 48 (P = 0.15), and 72 (P = 0.85) h associated with the use of gabapentin. Likewise, no difference in accumulative morphine consumption at 48 h following TKA or THA was found between gabapentin and placebo (DM = − 8.14, 95% CI − 18.55 to 2.28, P = 0.13). The incidence of opioid-related adverse effects, including nausea, pruritus, sedation, and dizziness, is no difference between gabapentin and placebo group. However, subgroup analysis indicated that gabapentin could reduce the incidence of pruritus after TKA (RR = 0.35, 95% CI 0.12 to 0.99, P = 0.05). Conclusion: Based on our meta-analysis, gabapentin did not decrease postoperative pain, cumulative morphine consumption, and the incidence of adverse effects after TKA and THA. There was not enough evidence to support the administrations of gabapentin for postoperative pain after TKA and THA.

“The use of bilateral continuous erector spinae plane blocks for postoperative analgesia after right‐sided living donor hepatectomy: A feasibility study”

“…There is emerging evidence that adding gabapentinoids to a perioperative analgesia regimen may be ineffective in postoperative pain scores. 35,36 In a recent systematic review and meta-analysis, gabapentinoids were not associated with a clinically meaningful improvement in postoperative pain. 37 We did not adjust for differences in patient related risk factors for increased postoperative pain, such as preoperative opioid intake, preoperative persistent pain, and a history of depression or anxiety.…”

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

“…Preemptive opioids should be especially avoided in opioid-naïve patients due to the risk of increasing postoperative pain perception and opioid use [180]. The use of perioperative gabapentinoids has been increasingly controversial owing to conflicting evidence of analgesic benefit and risks of adverse effects, including dizziness and synergistic sedation with concomitant opioids [61,[185][186][187][188][189][190]. The U.S. FDA has issued additional warnings regarding the risk of respiratory depression with gabapentinoids in patients who have respiratory risk factors, including the elderly, the renally impaired, those with chronic lung diseases, and those on concomitant sedatives [191].…”

Meta‐analyses of gabapentinoids for pain management after knee arthroplasty: A caveat emptor? A narrative review

“…A total of 9 meta‐analyses were identified 12‐19 —2 assessed gabapentin, 12,13 3 assessed pregabalin, 15‐17 and 1 assessed both gabapentin and pregabalin, with the analyses presented separately, 14 1 meta‐analysis combined data from TKA and total hip arthroplasty (THA) 17 but with separate TKA analysis. Of note, 2 recent meta‐analyses were not included because they combined data from TKA as well as THA 18,19 . A total of 9 gabapentin RCTs 20‐28 and 7 pregabalin RCTs 29‐35 were included in these meta‐analyses.…”

“…We performed a PubMed search on 1 December 2020 using the search terms: gabapentinoids, gabapentin, pregabalin, total knee arthroplasty, total knee replacement, systematic review, and metaanalysis. A total of 9 meta-analyses were identified [12][13][14][15][16][17][18][19] -2 assessed gabapentin, 12,13 3 assessed pregabalin, [15][16][17] and 1 assessed both gabapentin and pregabalin, with the analyses presented separately, 14 1 meta-analysis combined data from TKA and total hip arthroplasty (THA) 17 but with separate TKA analysis. Of note, 2 recent meta-analyses were not included because they combined data from TKA as well as THA.…”

“…Of note, 2 recent meta-analyses were not included because they combined data from TKA as well as THA. 18,19 A total of 9 gabapentin RCTs [20][21][22][23][24][25][26][27][28] and 7 pregabalin RCTs [29][30][31][32][33][34][35] were included in these meta-analyses. Details of the meta-analyses are presented in Table 1.…”