6 randomized controlled trials involving 472 patients undergoing total knee arthroplasty (TKA) compared preemptive gabapentin combined with multimodal analgesia vs multimodal analgesia alone or placebo. The pooled outcomes of interest included postoperative pain, opioid consumption, adverse effects, length of hospital stay, range of motion, and inflammatory markers. The meta-analysis demonstrated no significant differences in pain scores or opioid consumption within 24 hours after surgery between groups. Although minor improvements in nausea, pruritus, and early range of motion were observed, these effects were transient and not clinically meaningful. Overall, the findings suggest that adding preemptive gabapentin to multimodal analgesia does not provide significant clinical benefits after TKA and is not supported for routine use based on the current evidence.