Perioperative gabapentinoid use lowers short-term opioid consumption following lower limb arthroplasty: Systematic review and meta-analysis

Abstract

Background: The management of post-operative pain and high levels of acute and chronic opioid use following total knee arthroplasty (TKA) and total hip arthroplasty (THA) remain challenges to the perioperative team. We performed a systematic review and meta-analysis to determine the opioid sparing effects, analgesic effects, and safety profile of perioperative gabapentinoid usage in lower limb arthroplasty.Methods: We searched multiple databases from inception until May 2019 and included randomized controlled trials (RCT) on perioperative gabapentinoids in lower limb arthroplasty. The primary outcome was cumulative opioid consumption (oral morphine equivalents) at 24 and 48 hours, and the secondary outcomes were pain scores, time to hospital discharge, and adverse events including nausea, vomiting, pruritus, and sedation. Methodological quality was assessed using the Cochrane tool. The grading of recommendations assessment, development, and evaluation methodology for the certainty of evidence was also used.Results: We included 19 RCT involving 2,455 patients undergoing lower limb arthroplasty. The overall methodological quality of included studies was good. Gabapentinoid use was associated with a significant reduction in opioid consumption at 24 hour (mean difference (MD) 22.81 mg [95 percent Confidence Interval (CI) 13.64-31.98]) and 48 hour (MD 44.03 mg [95 percent CI 16.92-71.14]). We found no meaningful difference in pain scores at rest between gabapentinoid and placebo groups at 24 or 48 hours. Gabapentinoid use reduced the risk of postoperative nausea (risk ratio (RR) 0.69 [95 percent CI 0.57-0.82]), vomiting (RR 0.65 [95 percent CI 0.47-0.91]), and pruritus (RR 0.60 [0.37-0.98]), but not sedation (RR 1.25 [0.76-2.06]). There was no effect on time to discharge from hospital (MD—0.05 days [95 percent CI −0.31 to 0.20].Conclusions: The addition of gabapentinoids to perioperative multimodal analgesia decreases opioid consumption following lower limb arthroplasty, while also lowering rates of nausea, vomiting, and pruritus. Further study is required to evaluate the effect of gabapentinoid use on long-term opioid use and dependence.

Risk of major adverse events associated with gabapentinoid and opioid combination therapy: A systematic review and meta-analysis

“…Most previous systematic reviews and meta-analyses have focused on the perioperative use of gabapentinoids ( Liu et al, 2017 ; Verret et al, 2020 ; Campbell et al, 2021 ). We evaluated the risk of opioid and gabapentinoid combination for any type of pain.…”

“…Also, simultaneous use of gabapentinoids with an opioid may change the risk of adverse events associated with opioid use ( Kardas et al, 2020 ). A recent meta-analysis showed that the perioperative therapy of administering a gabapentinoid with an opioid in patients with lower limb arthroplasty reduced the risk of postoperative nausea, vomiting, and pruritus, but not sedation ( Campbell et al, 2021 ). This meta-analysis included only randomized controlled trial (RCT) studies that mostly focused on the short-term use of perioperative analgesics.…”

Donor Cardiac Troponin for Prognosis of Adverse Outcomes in Cardiac Transplantation Recipients: a Systematic Review and Meta-analysis

“…54 Although this systematic review and meta-analysis suggests that donor troponin is unlikely to predict adverse outcomes following cardiac transplantation, the addition of other potentially prognostic donor serum parameters such as B-type natriuretic peptide and, more recently, donor-derived cell-free DNA into multibiomarker prognostic models could enrich clinical evaluation and prognostication. 2,[55][56][57][58][59] Donor-derived cell-free DNA, in particular, has shown remarkable promise in the detection of allograft rejection in both cardiac and renal transplantation 57,60 ; whether or not early measurements could be prognostic for future adverse outcomes remains to be investigated in prognostic marker studies. 61 Future high-quality studies with comprehensive, nonselective study reporting of baseline characteristics and results and consideration of important confounders through multivariable analyses are needed in the identification of potentially prognostic factors in cardiac transplantation and validate their inclusion in sophisticated prognostic modeling.…”

Epidemiology of persistent postoperative opioid use after cardiac surgery: a systematic review and meta-analysis

“…Prescription opioids continue to play a central role in the management of moderate-to-severe pain after major surgery, including cardiac surgery. 1,2 Several systematic reviews have explored persistent postoperative opioid use after surgery, but none have included studies on cardiac surgery. 3e5 An understanding of the epidemiology of persistent postoperative opioid use in patients undergoing cardiac surgerydincluding its incidence and risk factorsdis of public health importance and could be used to guide clinical practice and opioid stewardship programmes.…”