The efficacy of perioperative gabapentin for the treatment of postoperative pain following total knee and hip arthroplasty: a meta-analysis

Jiayu Kang,Xinlong Ma,Lei Sun,Bin Lu,Zhihu Zhao,Benchao Dong,Jianxiong Ma,Jianwei Lv

doi:10.1186/s13018-020-01849-6

Abstract

BackgroundPostoperative 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. This meta-analysis was performed to assess the efficacy and safety of gabapentin following TKA and THA.MethodElectronic databases including PubMed, EMBASE, Cochrane Central Register of Controlled Trials, MEDLINE, and ClinicalTrials.gov were comprehensively retrieved for randomized controlled trials from their inception to June 2019. A total of 7 studies, which compared the administration of gabapentin with that of placebo for the treatment of postoperative pain, were included in our meta-analysis. The meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.ResultThere was no difference in pain score at 24 (P = 0.87), 48 (P = 0.15), and 72 (P = 0.85) h associated with the use of gabapentin. Likewise, no difference in accumulative morphine consumption at 48 h following TKA or THA was found between gabapentin and placebo (DM = − 8.14, 95% CI − 18.55 to 2.28, P = 0.13). The incidence of opioid-related adverse effects, including nausea, pruritus, sedation, and dizziness, is no difference between gabapentin and placebo group. However, subgroup analysis indicated that gabapentin could reduce the incidence of pruritus after TKA (RR = 0.35, 95% CI 0.12 to 0.99, P = 0.05).ConclusionBased 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.

Highlights

Total knee arthroplasty (TKA) and total hip arthroplasty (THA) procedures are generally regarded as some of the most successful surgeries and provide significant benefit to patients with severe knee and hip functional impairment [1]
There was not enough evidence to support the administrations of gabapentin for postoperative pain after total knee arthroplasty (TKA) and THA
Seven randomized controlled trials compared the use of gabapentin after TKA (5 studies) or THA (2 studies) with that of placebo or no treatment (Fig. 1) [14,15,16,17,18,19,20]

Summary

Introduction

Total knee arthroplasty (TKA) and total hip arthroplasty (THA) procedures are generally regarded as some of the most successful surgeries and provide significant benefit to patients with severe knee and hip functional impairment [1]. Gabapentin has a molecular structure similar to that of the neurotransmitter γ-aminobutyric acid (GABA) and acts by inhibiting certain calcium channels, which can decrease the release of neurotransmitters so that it has an established role in the treatment of partial seizures as well as neuropathic pain conditions [8]. It has been indicated postoperatively for a variety of surgeries including TKA and THA to reduce postoperative pain and opioid consumption [9]. This meta-analysis was performed to assess the efficacy and safety of gabapentin following TKA and THA

Methods

Results

Discussion

Conclusion