Analgesic and sedative effects of perioperative gabapentin in total knee arthroplasty: a randomized, double-blind, placebocontrolled dose-finding study

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], P50.93. 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 5 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

Enhanced recovery after surgery: Pain management

“…However, gabapentinoids can cause sedation and dizziness and both these symptoms are undesirable for enhanced recovery. Some studies have failed to show analgesic benefit …”

Perioperative gabapentin as a component of multimodal analgesia for postoperative pain after total knee arthroplasty

“…Gabapentin has been used to treat postoperative acute and chronic pain following major lower limb surgery [7,[18][19][20][21]. However, a recent well-designed study found that the use of gabapentin cannot prevent acute postoperative pain following TKA, and it resulted in increased adverse reactions [12].…”

“…Gabapentinoid drugs have relatively mild side effects, but high doses can cause dizziness, sedation, nausea, loss of balance, lower limb edema, urinary retention, constipation, and pruritus [11,12,30]. Several studies using gabapentinoids for acute postsurgical pain have reported PONV.…”

“…post-surgical pain management [6][7][8][9][10][11]. However, a recent study suggested that gabapentin cannot prevent acute postoperative pain in TKA [12].…”

Anesthesia and Analgesia for Total Knee Arthroplasty

“…3,4 The "gabapentinoids section" gives no relevant information based on the many well-designed and even dose-finding studies of these drugs, mostly being negative. [5][6][7] Also, the review lacks focus on the potential adverse effects of these drugs. Furthermore, there is no mention of the potential for highdose preoperative steroids, with several positive randomized controlled trials.…”