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

Authors

  • Ryan Campbell, MD
  • Jacqueline Nguyen Khuong, MD
  • Zhengyang Liu, BBiomed
  • Carla Borg, MD
  • Sarah Jackson, BBiomed
  • Dhruvesh M. Ramson, MBBS (Hons)
  • Juliana Kok, MD
  • Ned Douglas, MD
  • Jahan C. Penny-Dimri, MBBS (Hons)
  • Luke A. Perry, MBBS (Hons)

DOI:

https://doi.org/10.5055/jom.2021.0635

Keywords:

total knee arthroplasty, total hip arthroplasty, gabapentin, pregabalin, perioperative medicine, analgesia

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.

Author Biographies

Ryan Campbell, MD

Department of Medicine, University of New South Wales, South Wales, Australia

Jacqueline Nguyen Khuong, MD

Department of Anaesthesia, Royal Melbourne Hospital, Parkville, Australia; Melbourne Medical School, University of Melbourne, Parkville Australia

Zhengyang Liu, BBiomed

Department of Anaesthesia, Royal Melbourne Hospital, Parkville, Australia; Melbourne Medical School, University of Melbourne, Parkville Australia

Carla Borg, MD

Department of Medicine, Monash University, Australia

Sarah Jackson, BBiomed

Department of Anaesthesia, Royal Melbourne Hospital, Parkville, Australia; Melbourne Medical School, University of Melbourne, Parkville Australia

Dhruvesh M. Ramson, MBBS (Hons)

Department of Surgery, Monash University, Clayton Australia

Juliana Kok, MD

Department of Anaesthesia, Royal Melbourne Hospital, Parkville, Australia

Ned Douglas, MD

Department of Anaesthesia, Royal Melbourne Hospital, Parkville, Australia

Jahan C. Penny-Dimri, MBBS (Hons)

Department of Surgery, Monash University, Clayton Australia

Luke A. Perry, MBBS (Hons)

Department of Anaesthesia, Royal Melbourne Hospital, Parkville, Australia

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Published

07/19/2021

How to Cite

Campbell, MD, R., J. N. Khuong, MD, Z. Liu, BBiomed, C. Borg, MD, S. Jackson, BBiomed, D. M. Ramson, MBBS (Hons), J. Kok, MD, N. Douglas, MD, J. C. Penny-Dimri, MBBS (Hons), and L. A. Perry, MBBS (Hons). “Perioperative Gabapentinoid Use Lowers Short-Term Opioid Consumption Following Lower Limb Arthroplasty: Systematic Review and Meta-Analysis”. Journal of Opioid Management, vol. 17, no. 3, July 2021, pp. 251-72, doi:10.5055/jom.2021.0635.

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