Opioid-sparing effect, but limited analgesic efficacy, with preop gabapentinoids in THA .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2022;10(10):9 BMC Musculoskelet Disord. 2016 Aug 30;17(1):373Seven randomized controlled trials were included in this meta-analysis evaluating the efficacy and safety of preoperative gabapentin and pregabalin for postoperative analgesia following total hip arthroplasty. In all studies, gabapentin and/or pregabalin were compared to either placebo or no intervention. Pooled results demonstrated significantly lower cumulative morphine consumption with gabapentin compared to control up to 24 hours after surgery, and with pregabalin compared to control up to 48 hours after surgery. In contrast, pooled pain scores at rest or on mobilization did not demonstrate significantly lower scores with either gabapentin or pregabalin compared to control. In fact, pain scores during mobilization after 48 hours were significantly higher among gabapentin groups compared to control groups.
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La valutazione dei criteri di segnalazione valuta la trasparenza con cui gli autori riportano le caratteristiche metodologiche e sperimentali dello studio all'interno della pubblicazione. La valutazione è suddivisa in cinque categorie che vengono presentate di seguito.
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Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
L'Indice di Fragilità è uno strumento che aiuta l'interpretazione dei risultati significativi, fornendo una misura della forza di un risultato. L'Indice di Fragilità rappresenta il numero di eventi consecutivi che devono essere aggiunti a un risultato dicotomico per rendere il risultato non più significativo. Un numero piccolo rappresenta un risultato più debole, mentre un numero grande rappresenta un risultato più forte.
Perché questo studio era necessario ora?
One of the most important areas of research regarding perioperative treatment of patients undergoing total hip arthroplasty is postoperative analgesia. Patient-controlled analgesia with opioids remains a standard method of analgesia, although the undesirable side-effects of opioids have led to an emphasis on trying to limit their administration to only rescue analgesia and improve primary treatment. Gabapentinoids, such as gabapentin and pregabalin, have been suggested as medications with possible analgesic efficacy in these patients.
Qual era la domanda di ricerca principale?
What are the efficacy and safety profiles of preoperative gabapentin and pregabalin, compared to control, for analgesia following total hip arthroplasty?
- Pooled cumulative morphine consumption was significantly lower among gabapentin groups compared to control after 24h (MD -2.65 [95%CI -3.67, -1.63]; p<0.001) but not 48h (MD 0.00 [95%CI -7.69, 7.69]; p=1.000), while it was significantly lower for pregabalin compared to control after both 24 (MD -19.42 [95%CI -11.72, -3.93]; p<0.001) and 48h (MD -33.02 [95%CI -45.86, -20.19]; p<0.001).
- VAS pain at rest and at 24h did not significantly differ between gabapentin and control (MD 0.32 [95%CI -0.03, 0.67]; p=0.076), and pregabalin and control (MD -3.05 [95%CI -11.63, 5.53]; p=0.486). VAS pain at rest was significantly higher with gabapentin compared to control after 48h (MD 0.41 [95%CI 0.00-0.81]; p=0.049).
- VAS pain with mobilization between gabapentin and control did not significantly differ after 24h (MD 0.72 [95%CI -0.23, 1.66]), and was significantly higher among gabapentin groups after 48h (MD 1.90 [95%CI 0.04-3.75]; p=0.045). No significant difference in VAS pain with mobilization between pregabalin and control was observed after 24h (MD -0.78 [95%CI -6.91, 5.35]; p=0.803).
- No significant difference between gabapentin/pregabalin groups overall and control groups was observed in the incidences of vomiting (RR 0.95 [95%CI 0.47-1.92]), dizziness (RR 0.82 [95%CI 0.51-1.33]), or pruritus (RR 0.89 [95%CI 0.57-1.39]). A significantly lower incidence of nausea was observed with gabapentin/pregabalin groups compared to control (RR 0.49 [95%CI 0.27-0.92]).
Che cosa devo ricordare di più?
In total hip arthroplasty, an opioid-sparing effect was observed with preoperative gabapentin up to 24 hours after surgery, and with preoperative pregabalin up to 48 hours after surgery. However, neither treatment provided a significant benefit compared to the control group for pain at rest or on movement. In contrast, pooled pain scores during movement were actually higher in gabapentin groups compared to control groups after 48 hours.
Come influenzerà l'assistenza ai miei pazienti?
While there may be a short-term reduction in opioid requirement with the use of either gabapentin or pregabalin following total hip arthroplasty, these interventions do not appear to significantly reduce short-term pain scores in patients. Therefore, their role in postoperative analgesia following total hip arthroplasty should be scrutinized based on the currently available data. It is important to note limitations of the available body of evidence, as only 2-3 studies were available to separately assess the efficacy and safety of gabapentin and pregabalin each indicating the need to further large randomized controlled trials.
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