The Impact of Pre-emptive Large Dose of Methylprednisolone Combined With Gabapentin on Pain Treatment and Convalescence After Total Knee Arthroplasty in Elderly. A Randomized Control Study

Abstract

Background The aim of the study was to assess whether administration of gabapentin and methylprednisolone as “pre-emptive analgesia” in a group of patients above 65 years of age would be effective in complex pain management therapy following total knee arthroplasty (TKA). Material and Methods One hundred seventy, above 65 years old patients were qualified for the study, and 10 patients were excluded due to clinical situation. One hundred sixty patients were double-blind randomized into two groups: the study (eighty patients) and controls (eighty patients). The study group received as “pre-emptive” analgesia a single dose of 300 mg oral gabapentin and 125 mg intravenous methylprednisolone, while the others placebo. Perioperatively, all the patients received opioid and nonopioid analgesic agents calculated for 1 kg of body weight. We measured the levels of inflammatory markers (leukocytosis, C-reactive protein - CRP), pain intensity level at rest (numerical rating scale - NRS), the life parameters and all complications. Results Following administration of gabapentin and methylprednisolone as “pre-emptive” analgesia CRP values being lower on all postoperative days ( 1, 2 days - p<0,00001, 3 day – p=000538), leukocytosis on day 2 (p<0,0086) and 3 (p<0,00042), the NRS score at rest 6, 12 (p<0,000001), 18 (p<0,00004) and 24 (p=0,005569) hours postoperatively . Methylprednisolone with gabapentin significantly decreased the dose of parenteral opioid preparations (p=0,000006). The duration time of analgesia was significantly longer in study group (p<0,000001). No infectious complications were observed; in the control group, one patient manifested transient ischaemic attack (TIA). Conclusion The use of gabapentin and methylprednisolone at a single dose decreases the level of postoperative pain on the day of surgery, the dose of opioid analgesic preparations, the level of inflammatory parameters without infectious processes.