The effect of pregabalin on acute postoperative pain in patients undergoing total knee arthroplasty: A meta-analysis

Abstract

Objective: The purpose of this systematic review and meta-analysis of randomised controlled trials (RCTs) was to evaluate the effect of pain control of pregabalin versus placebo after a total knee arthroplasty (TKA).

Methods: The electronic databases: Medline, Embase, PubMed, CENTRAL (Cochrane Controlled Trials Register), Web of Science and Google were searched from inception to February 2016. This systematic review and meta-analysis were performed according to the PRISMA statement criteria. The primary endpoint was the visual analogue scale (VAS) after a TKA with rest or mobilization at 24 h and 48 h, which represents the effect of pain control after TKA. The cumulative morphine consumption is also assessed to the morphine-sparing effect. The complications of nausea, vomiting, dizziness and sedation were also compiled to assess the safety of pregabalin. Software Stata 12.0 was used for the meta-analysis. After testing for publication bias and heterogeneity across studies, data were aggregated for random-effects modelling when necessary.

Results: Six clinical trials with 769 patients were used for the meta-analysis. The meta-analysis indicated that pregabalin can decrease the VAS with rest at 24 h (MD = -8.14; 95% CI -12.57 to -3.71; P < 0.001) and 48 h (MD = -7.34; 95% CI -11.65 to -3.02; P < 0.001). Pregabalin can decrease the VAS with mobilization at 24 h (MD = -6.56; 95% CI -10.45 to -2.66; P = 0.001) and 48 h (MD = -9.62; 95% CI -12.80 to -6.44; P < 0.001). The results indicated that perioperative pregabalin can decrease the cumulative morphine consumption at 24 h (SMD = -0.97; 95% CI -1.17 to -0.78; P < 0.001) and 48 h (MD = -2.23; 95% CI -2.48 to -1.97; P < 0.001). Moreover, pregabalin can decrease the occurrence of nausea and vomiting but increase the occurrence of dizziness and sedation.

Conclusion: Based on the current meta-analysis, pregabalin has an analgesic and opioid-sparing effect in acute postoperative pain management without increasing the rate of nausea, vomiting.

Keywords: Meta-analysis; Pain management; Pregabalin; Randomised controlled trials; Total knee arthroplasty.