Abstract
Background
Gabapentinoids are commonly used as an adjunct to traditional pain management strategies
after total joint arthroplasty (TJA). The purpose of this study is to evaluate the
efficacy and safety of gabapentinoids in primary TJA to support the combined clinical
practice guidelines of the American Association of Hip and Knee Surgeons, American
Academy of Orthopaedic Surgeons, Hip Society, Knee Society, and the American Society
of Regional Anesthesia and Pain Management.
Methods
The MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were searched
for studies published prior to November 2018 on gabapentinoids in TJA. All included
studies underwent qualitative and quantitative homogeneity testing followed by a systematic
review and direct comparison meta-analysis to assess the efficacy and safety of gabapentinoids.
Results
In total, 384 publications were critically appraised to provide 13 high-quality studies
regarded as the best available evidence for analysis. In the perioperative period
prior to discharge, pregabalin reduces postoperative opioid consumption, but gabapentinoids
do not reduce postoperative pain. After discharge, gabapentin does not reduce postoperative
pain or opioid consumption, but pregabalin reduces both postoperative pain and opioid
consumption.
Conclusion
Moderate evidence supports the use of pregabalin in TJA to reduce postoperative pain
and opioid consumption. Gabapentinoids should be used with caution, however, as they
may lead to an increased risk of sedation and respiratory depression especially when
combined with other central nervous system depressants such as opioids.
Keywords
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Article info
Publication history
Published online: May 26, 2020
Accepted:
May 18,
2020
Received:
April 23,
2020
Footnotes
One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2020.05.033.
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