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Perioperative Gabapentin May Reduce Opioid Requirement for Early Postoperative Pain in Patients Undergoing Anterior Cruciate Ligament Reconstruction: A Systematic Review of Randomized Controlled Trials

Published:December 07, 2022DOI:https://doi.org/10.1016/j.arthro.2022.11.024

      Purpose

      To evaluate the efficacy of perioperative gabapentin or pregabalin treatment on postoperative pain and opioid requirement reduction in patients undergoing anterior cruciate ligament reconstruction (ACLR).

      Methods

      A systematic review of randomized control trials was conducted evaluating the effect of gabapentin or pregabalin on postoperative pain and opioid requirement for patients undergoing ACLR. The primary outcomes assessed were postoperative pain scores and opioid requirements. Secondary outcomes were complications, side effects, dosage, and timing of intervention.

      Results

      The initial search query identified 151 studies and 6 studies were included after full-text articles were reviewed. Three studies investigated the use of gabapentin and three studies investigated pregabalin. All three gabapentin studies reported significantly decreased or equivalent pain scores while also significantly reducing or removing total opioid consumption compared to control groups. Pregabalin demonstrated inconsistent efficacy for pain control and opioid consumption parameters across three studies. One study (pregabalin, n = 1) reported significantly increased incidence of dizziness with pregabalin compared to placebo.

      Conclusion

      There is moderate evidence demonstrating that preoperative gabapentin may be safe and effective in reducing postoperative pain and opioid consumption after ACLR. Gabapentin may be considered when employed as part of a multimodal analgesia regimen; however, the optimal protocol has yet to be determined. Currently, there is limited evidence demonstrating the efficacy of pregabalin on pain and opioid consumption in the setting of ACLR.

      Level of Evidence

      Systematic Review of Level I Studies
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      References

        • Kavak akelma F.
        • Baran Akkus İ.
        • Altinskoy S.
        • Özkan D.
        • ERGİL J.
        The effects of pregabalin and adductor canal block on postoperative pain in arthroscopic anterior cruciate ligament reconstruction.
        Turk J Med Sci. 2020; 50: 195-204https://doi.org/10.3906/sag-1906-66
        • Secrist E.S.
        • Freedman K.B.
        • Ciccotti M.G.
        • Mazur D.W.
        • Hammoud S.
        Pain Management After Outpatient Anterior Cruciate Ligament Reconstruction: A Systematic Review of Randomized Controlled Trials.
        Am J Sports Med. 2016; 44: 2435-2447https://doi.org/10.1177/0363546515617737
        • Dargel J.
        • Schmidt-Wiethoff R.
        • Fischer S.
        • Mader K.
        • Koebke J.
        • Schneider T.
        Femoral bone tunnel placement using the transtibial tunnel or the anteromedial portal in ACL reconstruction: a radiographic evaluation.
        Knee Surg Sports Traumatol Arthrosc. 2009; 17: 220-227https://doi.org/10.1007/s00167-008-0639-2
        • Alentorn-Geli E.
        • Lajara F.
        • Samitier G.
        • Cugat R.
        The transtibial versus the anteromedial portal technique in the arthroscopic bone-patellar tendon-bone anterior cruciate ligament reconstruction.
        Knee Surg Sports Traumatol Arthrosc. 2010; 18: 1013-1037https://doi.org/10.1007/s00167-009-0964-0
        • Mardani-Kivi M.
        • Mobarakeh M.K.
        • Keyhani S.
        • Motlagh K.H.
        • Ekhtiari K.S.
        Is Gabapentin Effective on Pain Management after Arthroscopic Anterior Cruciate Ligament Reconstruction? A Triple Blinded Randomized Controlled Trial.
        Arch Bone Jt Surg. 2013; 1: 18-22
        • Bang S.R.
        • Yu S.K.
        • Kim T.H.
        Can Gabapentin Help Reduce Postoperative Pain in Arthroscopic Rotator Cuff Repair? A Prospective, Randomized, Double-Blind Study.
        Arthroscopy. 2010; 26: S106-S111https://doi.org/10.1016/j.arthro.2009.11.010
        • Weinbroum A.A.
        Non-opioid IV adjuvants in the perioperative period: Pharmacological and clinical aspects of ketamine and gabapentinoids.
        Pharmacological Research. 2012; 65: 411-429https://doi.org/10.1016/j.phrs.2012.01.002
        • Moutzouros V.
        • Jildeh T.R.
        • Tramer J.S.
        • et al.
        Can We Eliminate Opioids After Anterior Cruciate Ligament Reconstruction? A Prospective, Randomized Controlled Trial.
        Am J Sports Med. 2021; 49: 3794-3801https://doi.org/10.1177/03635465211045394
        • Cho E.A.
        • Kim N.
        • Lee B.
        • Song J.
        • Choi Y.S.
        The Effect of Perioperative Pregabalin on Pain after Arthroscopic Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial.
        JCM. 2019; 8: 1426https://doi.org/10.3390/jcm8091426
        • Kehlet H.
        • Dahl J.B.
        The Value of Multimodal or Balanced Analgesia in Postoperative Pain Treatment.
        Anesthesia & Analgesia. 1993; 77: 1048-1056https://doi.org/10.1213/00000539-199311000-00030
        • Sebastian B.
        Effect of Oral Pregabalin as Preemptive Analgesic in Patients Undergoing Lower Limb Orthopedic Surgeries under Spinal Anaesthesia.
        J Clinic Diagn Res. 2016; 10: UC01-UC04https://doi.org/10.7860/JCDR/2016/18854.8081
        • Tobias A.F.
        • Moura E.C.R.
        • Honda CA.d.O.
        • et al.
        Evaluation of the Efficacy of Prolonged Pregabalin Administration Before and After Surgery in Patients Undergoing Arthroscopic Anterior Cruciate Ligament Repair: A Prospective, Randomized, Double-blind Study.
        The Clinical Journal of Pain. 2020; 36: 584-588https://doi.org/10.1097/AJP.0000000000000841
        • Hannon C.P.
        • Fillingham Y.A.
        • Browne J.A.
        • et al.
        The Efficacy and Safety of Gabapentinoids in Total Joint Arthroplasty: Systematic Review and Direct Meta-Analysis.
        The Journal of Arthroplasty. 2020; 35: 2730-2738.e6https://doi.org/10.1016/j.arth.2020.05.033
        • Han C.
        • Li X.D.
        • Jiang H.Q.
        • Ma J.X.
        • Ma X.L.
        The use of gabapentin in the management of postoperative pain after total knee arthroplasty: A PRISMA-compliant meta-analysis of randomized controlled trials.
        Medicine (Baltimore). 2016; 95: e3883https://doi.org/10.1097/MD.0000000000003883
        • Nimmaanrat S.
        • Tangtrakulwanish B.
        • Klabklay P.
        • Boonriong T.
        Perioperative Administration of Pregabalin in Patients Undergoing Arthroscopic Anterior Cruciate Ligament Reconstruction: Does It Help to Relieve Postoperative Pain?.
        J Med Assoc Thai. 2012; 95: 1297-1301
        • Schmidt P.C.
        • Ruchelli G.
        • Mackey S.C.
        • Carroll I.R.
        Perioperative Gabapentinoids.
        Anesthesiology. 2013; 119: 1215-1221https://doi.org/10.1097/ALN.0b013e3182a9a896
        • Page M.J.
        • McKenzie J.E.
        • Bossuyt P.M.
        • et al.
        The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.
        Syst Rev. 2021; 10: 89https://doi.org/10.1186/s13643-021-01626-4
        • Mustafa R.A.
        • Santesso N.
        • Brozek J.
        • et al.
        The GRADE approach is reproducible in assessing the quality of evidence of quantitative evidence syntheses.
        Journal of Clinical Epidemiology. 2013; 66: 736-742.e5https://doi.org/10.1016/j.jclinepi.2013.02.004
        • McCormick F.
        • Cvetanovich G.L.
        • Kim J.M.
        • et al.
        An assessment of the quality of rotator cuff randomized controlled trials: utilizing the Jadad score and CONSORT criteria.
        Journal of Shoulder and Elbow Surgery. 2013; 22: 1180-1185https://doi.org/10.1016/j.jse.2013.01.017
        • Lee L.
        • Tran T.
        • Mayo N.E.
        • Carli F.
        • Feldman L.S.
        What does it really mean to “recover” from an operation?.
        Surgery. 2014; 155: 211-216https://doi.org/10.1016/j.surg.2013.10.002
        • Ménigaux C.
        • Adam F.
        • Guignard B.
        • Sessler D.I.
        • Chauvin M.
        Preoperative Gabapentin Decreases Anxiety and Improves Early Functional Recovery from Knee Surgery.
        Anesthesia & Analgesia. 2005; 100: 1394-1399https://doi.org/10.1213/01.ANE.0000152010.74739.B8
        • Khetarpal R.
        • Kataria A.
        • Bajaj S.
        • Kaur H.
        • Singh S.
        Gabapentin vs pregabalin as a premedication in lower limb orthopaedics surgery under combined spinal epidural technique.
        Anesth Essays Res. 2016; 10: 262https://doi.org/10.4103/0259-1162.172339
        • Basavareddy A.
        • Meher B.
        • Rajendran I.
        • Srinivasan S.
        Prospective, randomised, double blinded controlled trial of gabapentin and pregabalin as pre emptive analgesia in patients undergoing lower abdominal and limb surgery under spinal anaesthesia.
        Indian J Pain. 2014; 28: 155https://doi.org/10.4103/0970-5333.138450
        • Davey M.S.
        • Hurley E.T.
        • Anil U.
        • et al.
        Pain Management Strategies After Anterior Cruciate Ligament Reconstruction: A Systematic Review With Network Meta-analysis.
        Arthroscopy. 2021; 37: 1290-1300.e6https://doi.org/10.1016/j.arthro.2021.01.023
        • Maheshwer B.
        • Knapik D.M.
        • Polce E.M.
        • Verma N.N.
        • LaPrade R.F.
        • Chahla J.
        Contribution of Multimodal Analgesia to Postoperative Pain Outcomes Immediately After Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Level 1 Randomized Clinical Trials.
        Am J Sports Med. 2021; 49: 3132-3144https://doi.org/10.1177/0363546520980429
        • Faunø P.
        • Lund B.
        • Christiansen S.E.
        • Gjøderum O.
        • Lind M.
        Analgesic Effect of Hamstring Block After Anterior Cruciate Ligament Reconstruction Compared With Placebo: A Prospective Randomized Trial.
        Arthroscopy. 2015; 31: 63-68https://doi.org/10.1016/j.arthro.2014.07.024
        • Iskandar H.
        Femoral block provides superior analgesia compared with intra-articular ropivacaine after anterior cruciate ligament reconstruction.
        Regional Anesthesia and Pain Medicine. 2003; 28: 29-32https://doi.org/10.1053/rapm.2003.50019
        • Lynch J.R.
        • Okoroha K.R.
        • Lizzio V.
        • Yu C.C.
        • Jildeh T.R.
        • Moutzouros V.
        Adductor Canal Block Versus Femoral Nerve Block for Pain Control After Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Trial.
        Am J Sports Med. 2019; 47: 355-363https://doi.org/10.1177/0363546518815874
        • Bailey L.
        • Griffin J.
        • Elliott M.
        • et al.
        Adductor Canal Nerve Versus Femoral Nerve Blockade for Pain Control and Quadriceps Function Following Anterior Cruciate Ligament Reconstruction With Patellar Tendon Autograft: A Prospective Randomized Trial.
        Arthroscopy. 2019; 35: 921-929https://doi.org/10.1016/j.arthro.2018.10.149