Prognia
Back to Guidelines
American Association of Hip and Knee SurgeonsOrthopaedic Surgery2020advanced

Gabapentinoids in Total Joint Arthroplasty

Published by American Association of Hip and Knee Surgeons (AAHKS) · AAOS Clinical Practice Guidelines and Systematic Review Methodology

3Recommendations
19References

Summary

AI-generated

This clinical practice guideline evaluates the efficacy and safety of gabapentinoids in primary total joint arthroplasty (TJA). It concludes that while gabapentinoids do not significantly reduce postoperative pain in the perioperative period, pregabalin does reduce opioid consumption. Post-discharge, pregabalin effectively reduces pain and opioid use, whereas gabapentin does not. The guideline advises caution, particularly regarding respiratory depression when used concurrently with opioids and increased risks of confusion and sedation in elderly patients.

total joint arthroplastygabapentinoidspregabalingabapentinAAHKSorthopaedic surgeryguidelinespostoperative pain

Key Takeaways

  • 1
    Perioperative gabapentinoids do not reduce postoperative pain, but pregabalin reduces opioid consumption.
  • 2
    Pregabalin used after discharge reduces postoperative pain, neuropathic pain, and opioid consumption.
  • 3
    Gabapentin used after discharge does not reduce pain or opioid consumption.
  • 4
    There is no difference in efficacy between low-dose and high-dose gabapentinoids.
  • 5
    Gabapentinoids should be used cautiously due to increased risk of confusion in elderly patients and respiratory depression when combined with opioids.

Key Recommendations

Guideline Question 1

  • 1

    In the perioperative period after primary TJA, gabapentinoids do not reduce postoperative pain, but pregabalin reduces opioid consumption.

    StrongEvidence: HighTreatment

Guideline Question 2

  • 2

    Pregabalin after discharge reduces postoperative pain, neuropathic pain, and opioid consumption after primary TJA, but gabapentin does not reduce pain or opioid consumption.

    StrongEvidence: HighTreatment

Guideline Question 3

  • 3

    There is no difference in postoperative pain, opioid consumption, or complications between low-dose and high-dose gabapentinoids. However, the use of gabapentinoids may lead to increased risk of confusion among elderly patients and respiratory depression with concurrent use of opioids.

    ModerateEvidence: HighTreatment

Scope & Objectives

Clinical Topic

Total Joint Arthroplasty

Objectives

To improve the treatment of orthopaedic surgical patients and reduce practice variation by promoting a multidisciplinary evidenced-base approach on the use of gabapentinoids following primary TJA.

Target Patient Population

Patients undergoing primary total joint arthroplasty (TJA)

Target Providers

Orthopaedic SurgeonsAnesthesiologists

Patient Criteria & Setting

Therapeutic Area

Postoperative Pain Management

Guideline Scope

TreatmentManagement

Care Settings

PerioperativePost-discharge

Special Populations

Elderly

Evidence Grading

System: AAOS Clinical Practice Guidelines and Systematic Review Methodology

Safety & Contraindications

Contraindications

  • Patients with underlying respiratory depression (relative caution)
  • Concurrent use of central nervous system depressants such as opioids (relative caution)

Monitoring Guidance

Use cautiously when given concurrently with opioids due to risk of respiratory depression, and monitor elderly patients closely for postoperative sedation and confusion. The lowest clinically efficacious dose should be used.

Authors & Contributors

Charles P. HannonYale A. FillinghamJames A. BrowneEmil H. SchemitschAsokumar BuvanendranWilliam G. HamiltonCraig J. Della Valle

Guideline Features

Dosing informationBased on systematic reviewMultidisciplinaryDrug interactions discussed

Learning Context

Difficulty

advanced

Learning Paths

Total Joint ArthroplastyPostoperative Pain ManagementGabapentinoidsOpioid-Sparing StrategiesOrthopaedic SurgeryPerioperative Care