American Association of Hip and Knee Surgeons (AAHKS)
Gabapentinoids in Total Joint Arthroplasty
This guideline holds 3 recommendations and 19 references.
Summary
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.
The guidelines were developed collaboratively by multiple orthopaedic and pain medicine societies to address common questions regarding the efficacy and safety of gabapentinoids in primary TJA, utilizing systematic reviews and meta-analyses.
Key takeaways
Perioperative gabapentinoids do not reduce postoperative pain, but pregabalin reduces opioid consumption.
Pregabalin used after discharge reduces postoperative pain, neuropathic pain, and opioid consumption.
Gabapentin used after discharge does not reduce pain or opioid consumption.
There is no difference in efficacy between low-dose and high-dose gabapentinoids.
Gabapentinoids should be used cautiously due to increased risk of confusion in elderly patients and respiratory depression when combined with opioids.
Recommendations
Guideline Question 1
In the perioperative period after primary TJA, gabapentinoids do not reduce postoperative pain, but pregabalin reduces opioid consumption.
Population: Patients undergoing primary TJAWhen: Postoperative pain
Guideline Question 2
Pregabalin after discharge reduces postoperative pain, neuropathic pain, and opioid consumption after primary TJA, but gabapentin does not reduce pain or opioid consumption.
Population: Patients undergoing primary TJAWhen: Postoperative and neuropathic pain
Guideline Question 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.
Population: Patients undergoing primary TJAWhen: Postoperative pain and complications
