Evaluation of efficacy of oral pregabalin in reducing postoperative pain in patients undergoing total knee arthroplasty

Abstract

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.

The efficacy of pregabalin for the management of postoperative pain in primary total knee and hip arthroplasty: a meta-analysis

“…Our pooled data showed that pregabalin could decrease postoperative opioid consumption. This result agrees with those of other studies examining the administration of pregabalin [10, 14, 19]. Another meta-analysis showed that pregabalin can reduce 24-h morphine consumption in gynecologic, laparoscopic cholecystectomy, orthopedic, spine, and miscellaneous procedures [20].…”

“…Four studies [10–12, 14] were for TKA, while another three studies [15–17] were for THA, and there were 510 patients for TKA and 313 patients for THA. All of the articles had been published since 2008, and four of the articles had been published in the last 3 years.…”

“…However, different conclusions have been reached, and the efficacy of pregabalin for pain management among TKA and THA patients has remained unclear. Jain et al [10] reported that perioperative administration of pregabalin reduced opioid consumption, improved postoperative analgesia, and yielded higher patient satisfaction levels in primary TKA. However, Singla et al [11] showed that there was no significant difference between pregabalin and placebo with respect to the worst pain (24/48 h postsurgery) after TKA.…”

The effect of pregabalin and s-ketamine in total knee arthroplasty patients: A randomized trial

“…[1617] Due to its simplicity and low complication risk, it might replace locoregional techniques. [18] There is some evidence that pregabalin[1920212223] and s-ketamine[192425] may reduce acute pain, decrease opioid consumption, and even an incidence of chronic pain.…”

“…To make this transition successful, we needed some additional analgesics drugs. Consulting our pain team specialists and accepting multimodal analgesic strategy as standard practice in TKA patients,[19] we have chosen the addition of pregabalin[20212223] and s-ketamine[2425] to the standard regimen. After obtaining good results of our pilot study (LIA-PREGABA-KET),[18] we started this randomized, double-blind trial to evaluate the opioid-sparing effect and benefits of pregabalin and s-ketamine, when added to a multimodal, standardized postoperative analgesic regime of LIA, paracetamol, diclofenac, and patient-controlled analgesia (PCA)-piritramide compared to placebo.…”