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Total knee replacement is acknowledged as a successful and durable operation, but recovery from this surgery is often lengthy and painful. A great deal of attention has recently been directed at enhancing this recovery, most of which has focused on improvements in perioperative pain control. Various protocols have been suggested. Gabapentin (Neurontin) or pregabalin When it comes to treating or managing pain after knee replacement, your doctor may recommend additional natural approaches such as massage, acupuncture, or Gabapentin is routinely used in preoperative multimodal anesthesia to reduce pain following total joint arthroplasty (TJA) surgery. Evolving evidence has shown it is ineffective in reducing postoperative pain and should be used cautiously in this patient population due to its adverse effects. Pregabalin after discharge reduces postoperative pain, neuropathic pain, and opioid consumption after primary TJA, but gabapentin does not reduce pain or opioid consumption. Strength of Recommendation: Strong. Rationale: Six high quality studies evaluated the efficacy of post-discharge gabapentinoids on pain Based on our meta-analysis, gabapentin did not decrease postoperative pain, cumulative morphine consumption, and the incidence of adverse effects after TKA and THA. There was not enough evidence to support the administrations of gabapentin for postoperative pain after TKA and THA. Postoperative pain after total knee arthroplasty (TKA) and total hip arthroplasty (THA) influence patients’ rehabilitation and life quality. Although gabapentin has been widely used for analgesia, its efficacy is still controversial in TKA and THA. Perioperative gabapentin reduces 24 h opioid consumption and improves in-hospital rehabilitation but not post-discharge outcomes after total knee arthroplasty with peripheral nerve block J Bone Joint Surg Am 2006;88:959. 3. Hebl JR, Kopp SL, Ali MH, et al. A comprehensive anesthesia protocol that emphasizes peripheral nerve blockade for total knee and total hip arthroplasty. J Bone Joint Surg Am 2005;87:63. 4. Sharma S, Iorio R, Specht LM, Davies-Lepie S, Healy WL. Complications of femoral nerve block for total knee arthroplasty. We would like to show you a description here but the site won’t allow us. In summary, the administration of gabapentin was effective in decreasing postoperative narcotic consumption and the incidence of pruritus. There was a high risk of selection bias and a higher heterogeneity of knee flexion range in this analysis. Spinal cord stimulation for the treatment of chronic knee pain following total knee replacement. Pain Physician . 2010;13(3):251-256. Pizzi LT, Toner R, Foley K, et al. Relationship between potential opioid-related adverse effects and hospital length of stay in patients receiving opioids after orthopedic surgery. After discharge, gabapentin does not reduce postoperative pain or opioid consumption, but pregabalin reduces both postoperative pain and opioid consumption. Moderate evidence supports the use of pregabalin in TJA to reduce postoperative pain and opioid consumption. Perioperative gabapentin reduces 24 h opioid consumption and improves in-hospital rehabilitation but not post-discharge outcomes after total knee arthroplasty with peripheral nerve block. British Journal of Anaesthesia, 113(5), 855-864. However, perioperative gabapentin had a significant effect on promoting opioid cessation after surgery. MeaningSeventy-two hours of perioperative gabapentin use may promote opioid cessation after surgery and decrease the duration of postoperative opioid use. Pregabalin is accepted to be more potent, and with fewer adverse effects, than its class counterpart gabapentin. It has fast gastrointestinal absorption, a high bioavailability, and its serum representation is dose-proportional leading to a predictable and near-linear pharmacokinetic profile. 6 The maximum plasma concentration is reached at 1 h after oral administration, and its elimination Based on the current meta-analysis, gabapentin exerts an analgesic and opioid-sparing effect in acute postoperative pain management without increasing the rate of dizziness and pruritus. Total knee arthroplasty (TKA) is one of the most common surgeries performed on patients with osteoarthritis or rheumatic arthritis of the knee. Jorgensen CC, Pitter FT, Kehlet H. Lundbeck Foundation Center for Fast-track H, Knee Replacement Collaborative Group. Safety aspects of preoperative high-dose glucocorticoid in primary total knee replacement. Br J Anaesth 2017; 119:267–275. [Google Scholar] 43. In summary, the administration of gabapentin was effective in decreasing postoperative narcotic consumption and the incidence of pruritus. There was a high risk of selection bias and a higher heterogeneity of knee flexion range in this analysis. Pain management after total hip arthroplasty (THA) varies and has been widely studied in recent years. Gabapentin as a third-generation antiepileptic drug that selectively affects the nociceptive process has been used for pain relief after THA. This day trial, patients in the gabapentin group showed improved VAS pain scores and improved Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scores compared to patients in the naproxen group. In 2006, Sihoe et al. evaluated gabapentin in the treatment of chronic pain after chest surgery (6). This was a heterogeneous group of patients.
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