A Meta-analysis Of Gabapentin And Pregabalin In The Management Of Postoperative Pain After Total Knee Arthroplasty

Study Design Systematic review and meta-analysis.Objective To review the literature systematically and make a comprehensive understanding of the efficacy and safety of these 2 drugs in the management of postoperative pain after total knee arthroplasty.Background Recent years gabapentin and pregabalin have increasingly been used in the management of postoperative pain,with some relative meta-analysis shows improvement of analgesic effect and reduction of opioid consumption while introducing some side effect as well,such as sedation and dizziness.however, in most of the original trials included in those meta-analysis, gabapentin or pregabalin was most frequently administered as monotherapy(with opioid as rescue analgesics).Obviously it remains a question whether the addition of GBP/PGB into the multimodal analgesia regime for postoperative pain in total knee arthroplasty could still lead to additional clinical benefit.So far there’s no such system review or meta-analysis estimating the efficacy andsafety of GBP/PGB specifically on the procedure of total knee arthroplasty.Methods PubMed(1980 to present), adapted for EMBASE(1980 to preasent),Cochrane Central Register of Controlled Trials,CNKI,Wan Fang,Sino Med databases were searched for randomized controlled trials. All included studies were assessed for methodological validity using the Cochrane Collaboration’s tool for assessing risk of bias(intern validity) in randomized trials.Random effect model was used in our meta-analysis, and standard mean difference(SMD) was chosen as the pooled estimate.Results Thirteen trials containing 1,597 patient were included in our study. Eight included studies could be considered to be of high quality in methodology.The pooled results from meta-analysis demonstrated that compared with placebo, GBP/PGB significantly reduced the rest pain for postoperative day2 and the passive pain for postoperative day3,significantly increased the active knee range of motion on postoperative day3 and day4,while introducing significantly more side effect of visual disturbance and confusion as well.There shows no difference between the two group on early or late postoperative pain and knee function. Incidence of pruritus, dizziness/light headache,sedation/drowsiness were the same between both group.Conclusions As only light clinical benefit obtained from the usingof GBP/PGB,and with the relatively serious side effect it brings about,randomized controlled trials with large sample size are needed to determine the benefit vs. harm before adding GBP or PGB into the routine multimodal analgesia regime.