The efficacy of preoperative administration of gabapentin/pregabalin in improving pain after total hip arthroplasty: a meta-analysis

Yingdelong Mao, Lianguo Wu, Weiguo Ding, Yingdelong Mao, Lianguo Wu, Weiguo Ding

Abstract

Background: The purpose of this systematic review and meta-analysis of randomised controlled trials (RCTs) was to evaluate the pain control by gabapentin or pregabalin administration versus placebo after total hip arthroplasty (THA).

Methods: In January 2016, a systematic computer-based search was conducted in the Medline, Embase, PubMed, CENTRAL (Cochrane Controlled Trials Register), Web of Science and Google databases. This systematic review and meta-analysis were performed according to the PRISMA statement criteria. The primary endpoint was the cumulative morphine consumption and visual analogue scale (VAS) scores at 24 and 48 h with rest or mobilisation. The complications of vomiting, nausea, dizziness and pruritus were also compiled to assess the safety of gabapentin and pregabalin. Stata 12.0 software was used for the meta-analysis. After testing for publication bias and heterogeneity across studies, the data were aggregated for random-effects modelling when necessary.

Results: Seven studies involving 769 patients met the inclusion criteria. The meta-analysis revealed that treatment with gabapentin or pregabalin can decrease the cumulative morphine consumption at 24 h (mean difference (MD) = -7.82; 95 % CI -0.95 to -0.52; P < 0.001) and 48 h (MD = -6.90; 95 % CI -0.95 to -0.57; P = 0.118). Gabapentin or pregabalin produced no better outcome than placebo in terms of VAS score with rest at 24 h (SMD = 0.15; 95 % CI -0.17 to -0.48; P = 0.360) and with rest at 48 h (SMD = 0.22; 95 % CI -0.25 to 0.69; P = 0.363). There was no statistically significant difference between the groups with respect to the VAS score at 24 h postoperatively (SMD = 0.46; 95 % CI -0.19 to 1.11; P = 0.164) and at 48 h postoperatively (SMD = 1.15; 95 % CI -0.58 to 2.89; P = 0.193). Gabapentin decreased the occurrence of nausea (relative risk (RR), 0.49; 95 % CI 0.27-0.92, P = 0.025), but there was no significant difference in the incidence of vomiting, dizziness and pruritus.

Conclusions: On the basis of the current meta-analysis, gabapentin or pregabalin can decrease the cumulative morphine consumption and decrease the occurrence of nausea; however, further trials are needed to assess the efficacy of pain control by gabapentin or pregabalin.

Keywords: Gabapentin; Meta-analysis; Pregabalin; Total hip replacement.

Figures

Fig. 1
Fig. 1
The flow diagram of the included studies
Fig. 2
Fig. 2
The detailed bias summary of each study
Fig. 3
Fig. 3
The bias summary concluded in the above graph
Fig. 4
Fig. 4
Begg’s funnel plot with pseudo 95 % CI
Fig. 5
Fig. 5
The forest plot of occurrence of vomiting between the two groups
Fig. 6
Fig. 6
The forest plot of occurrence of nausea between the two groups
Fig. 7
Fig. 7
The forest plot of occurrence of dizziness between the two groups
Fig. 8
Fig. 8
The forest plot of occurrence of pruritus between the two groups

References

    1. Kahn SR, Shrier I, Kearon C. Physical activity in patients with deep venous thrombosis: a systematic review. Thromb Res. 2008;122(6):763–773. doi: 10.1016/j.thromres.2007.10.011.
    1. Charen DA, Qian ET, Hutzler LH, Bosco JA. Risk factors for postoperative venous thromboembolism in orthopaedic spine surgery, hip arthroplasty, and knee arthroplasty patients. Bull Hosp Jt Dis (2013) 2015;73(3):198–203.
    1. Karlsen APH, Geisler A, Petersen PL, Mathiesen O, Dahl JB. Postoperative pain treatment after total hip arthroplasty: a systematic review. Pain. 2015;156(1):8–30. doi: 10.1016/j.pain.0000000000000003.
    1. Liu SS, Bae JJ, Bieltz M, Ma Y, Memtsoudis S. Association of perioperative use of nonsteroidal anti-inflammatory drugs with postoperative myocardial infarction after total joint replacement. Reg Anesth Pain Med. 2012;37(1):45–50. doi: 10.1097/AAP.0b013e31823354f5.
    1. Jules-Elysee KM, Goon AK, Westrich GH, Padgett DE, Mayman DJ, Ranawat AS, et al. Patient-Controlled Epidural Analgesia or Multimodal Pain Regimen with Periarticular Injection After Total Hip Arthroplasty. J Bone Joint Surg Am. 2015;97(10):789–798. doi: 10.2106/JBJS.N.00698.
    1. Rothwell MP, Pearson D, Hunter JD, Mitchell PA, Graham-Woollard T, Goodwin L, et al. Oral Oxycodone Offers Equivalent Analgesia to Intravenous Patient-Controlled Analgesia After Total Hip Replacement: A Randomized, Single-Centre, Non-Blinded, Non-Inferiority Study. Br J Anaesth. 2011;106(6):865–872. doi: 10.1093/bja/aer084.
    1. Singla NK, Hale ME, Davis JC, Bekker A, Gimbel J, Jahr J, et al. IV acetaminophen: efficacy of a single dose for postoperative pain after hip arthroplasty: subset data analysis of 2 unpublished randomized clinical trials. Am J Ther. 2015;22(1):2–10. doi: 10.1097/MJT.0000000000000026.
    1. Umuroğlu T, Eti Z, Çiftçi H, Yilmaz Göğüş F. Analgesia for adenotonsillectomy in children: a comparison of morphine, ketamine and tramadol. Paediatr Anaesth. 2004;14(7):568–573. doi: 10.1111/j.1460-9592.2004.01223.x.
    1. Bannister K, Sikandar S, Bauer CS, Dolphin AC, Porreca F, Dickenson AH. Pregabalin suppresses spinal neuronal hyperexcitability and visceral hypersensitivity in the absence of peripheral pathophysiology. Anesthesiology. 2011;115(1):144–152. doi: 10.1097/ALN.0b013e31821f6545.
    1. Hurley RW, Chatterjea D, Rose Feng M, Taylor CP, Hammond DL. Gabapentin and pregabalin can interact synergistically with naproxen to produce antihyperalgesia. Anesthesiology. 2002;97(5):1263–1273. doi: 10.1097/00000542-200211000-00033.
    1. Carmichael NM, Katz J, Clarke H, Kennedy D, Kreder HJ, Gollish J. An intensive perioperative regimen of pregabalin and celecoxib reduces pain and improves physical function scores six weeks after total hip arthroplasty: a prospective randomized controlled trial. Pain Res Manag. 2013;18(3):127–132. doi: 10.1155/2013/258714.
    1. Clarke H, Pagé G, McCartney C, Huang A, Stratford P, Andrion J, et al. Pregabalin reduces postoperative opioid consumption and pain for 1 week after hospital discharge, but does not affect function at 6 weeks or 3 months after total hip arthroplasty. Br J Anaesth. 2015;115(6):903–911. doi: 10.1093/bja/aev363.
    1. Clarke H, Pereira S, Kennedy D, Andrion J, Mitsakakis N, Gollish J, et al. Adding gabapentin to a multimodal regimen does not reduce acute pain, opioid consumption or chronic pain after total hip arthroplasty. Acta Anaesthesiol Scand. 2009;53(8):1073–1083. doi: 10.1111/j.1399-6576.2009.02039.x.
    1. Martinez V, Cymerman A, Ben Ammar S, Fiaud JF, Rapon C, Poindessous F, et al. The analgesic efficiency of combined pregabalin and ketamine for total hip arthroplasty: a randomised, double‐blind, controlled study. Anaesthesia. 2014;69(1):46–52. doi: 10.1111/anae.12495.
    1. Mathiesen O, Jacobsen L, Holm H, Randall S, Adamiec-Malmstroem L, Graungaard BK, et al. Pregabalin and dexamethasone for postoperative pain control: a randomized controlled study in hip arthroplasty. Br J Anaesth. 2008;101(4):535–541. doi: 10.1093/bja/aen215.
    1. Paul JE, Nantha-Aree M, Buckley N, Shahzad U, Cheng J, Thabane L, et al. Randomized controlled trial of gabapentin as an adjunct to perioperative analgesia in total hip arthroplasty patients. Can J Anaesth. 2015;62(5):476–484. doi: 10.1007/s12630-014-0310-y.
    1. Rasmussen ML, Mathiesen O, Dierking G, Christensen BV, Hilsted KL, Larsen TK, et al. Multimodal analgesia with gabapentin, ketamine and dexamethasone in combination with paracetamol and ketorolac after hip arthroplasty: a preliminary study. Eur J Anaesthesiol. 2010;27(4):324–330. doi: 10.1097/EJA.0b013e328331c71d.
    1. Kardash KJ, Sarrazin F, Tessler MJ, Velly AM. Single-dose dexamethasone reduces dynamic pain after total hip arthroplasty. Anesth Analg. 2008;106(4):1253–1257. doi: 10.1213/ANE.0b013e318164f319.
    1. Fredrickson M, Danesh-Clough T. Spinal anaesthesia with adjunctive intrathecal morphine versus continuous lumbar plexus blockade: a randomised comparison for analgesia after hip replacement. Anaesth Intensive Care. 2015;43(4):449–453.
    1. Moore RA, Straube S, Wiffen PJ, Derry S, McQuay HJ. Pregabalin for acute and chronic pain in adults. Cochrane Database Syst Rev. 2009;8(3):CD007076.
    1. Peng PW, Wijeysundera DN, Li CC. Use of gabapentin for perioperative pain control–a meta-analysis. Pain Res Manag. 2007;12(2):85–92. doi: 10.1155/2007/840572.
    1. McCartney CJ, Sinha A, Katz J. A qualitative systematic review of the role of N-methyl-D-aspartate receptor antagonists in preventive analgesia. Anesth Analg. 2004;98(5):1385–1400. doi: 10.1213/01.ANE.0000108501.57073.38.
    1. Dworkin RH, Kirkpatrick P. Pregabalin. Nat Rev Drug Discov. 2005;4(6):455–456. doi: 10.1038/nrd1756.
    1. Yao Z, Shen C, Zhong Y. Perioperative Pregabalin for Acute Pain After Gynecological Surgery: A Meta-analysis. Clin Ther. 2015;37(5):1128–1135. doi: 10.1016/j.clinthera.2014.04.020.
    1. Eipe N, Penning J, Yazdi F, et al. Perioperative use of pregabalin for acute pain-a systematic review and meta-analysis. Pain. 2015;156(7):1284–1300. doi: 10.1097/j.pain.0000000000000173.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel