Fifty-eight adults undergoing primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) were randomized to pregabalin slow-dose escalation or single preoperative pregabalin dose alone. All patients received 75 mg pregabalin two hours before incision, but only one group (G1) received 37.5 mg twice the day before surgery, while the other (G2) received none. The primary outcome was postoperative dizziness severity (moderate/severe). Secondary outcomes included other adverse effects, time to readiness for transfers, time to readiness for discharge, and pain scores. Overall, the results of the study revealed that G1 had significantly lower rates of dizziness and nausea in the first six postoperative hours, lower opioid consumption, and greater success with independent transfers at six hours. Time to readiness for independent transfers was shorter in G1. Pain scores did not differ between groups on any day. These findings suggest that slow dose escalation mitigates early pregabalin-related side effects and enhances immediate postoperative mobility within enhanced recovery after surgery (ERAS) pathways.