Efficacy and safety of pregabalin for postoperative pain after total hip and knee arthroplasty: a systematic review and meta-analysis.

Introduction: The prevalence of osteoarthritis and postoperative neuropathic pain after arthroplasty highlights the necessity for improved pain management. Many patients develop chronic neuropathic pain, necessitating targeted interventions. Research on pregabalin's effectiveness in pain relief has yielded conflicting findings, necessitating further exploration to determine its therapeutic value. This study sought to assess pregabalin's efficacy and safety in postoperative pain management, reconcile inconsistent literature, and enhance understanding of its clinical use.

Methods: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search was conducted across four major databases to select clinical trials. Statistical analysis was performed using Review Manager 5.4.1, applying fixed- or random-effects models depending on heterogeneity (I). Subgroup analyses were conducted based on the type, timing, and dosage of pregabalin administered.

Results: Pregabalin was associated with significantly reduced pain during movement at 24 h (MD -0.62, 95%CI -1.02 to -0.23), 48 h (MD -0.53, 95%CI -0.90 to -0.15), and 72 h (MD -0.59, 95%CI -1.05 to -0.12) post-surgery. Opioid consumption was also significantly lower at 24 h (SMD - 0.50, 95%CI -0.80 to -0.20), 48 h (SMD - 0.76, 95%CI -1.34 to -0.19), and 72 h (SMD - 1.33, 95%CI -2.16 to -0.49). While there were no significant improvements in the range of motion at 24 and 48 h, pregabalin was associated with significantly enhanced range of motion at 72 h (SMD 1.11, 95%CI 0.12, 2.09). Treatment with pregabalin was associated with a significant decrease in the odds of nausea (OR 0.30, 95%CI 0.09 to 0.99) and vomiting after total knee arthroplasty (TKA) (OR 0.17, 95%CI 0.04 to 0.65). Additionally, pregabalin exposure was associated with increased sedation after TKA (OR 2.27, 95%CI, 1.13 to 4.56) and total hip arthroplasty (THA) (OR 2.54, 95%CI 1.11 to 5.79), as well as blurred vision at 24 h in TKA/THA patients (OR 4.68, 95%CI 1.37 to 15.99; n = 95; I2 = 34). There was no significant association with other adverse events. The administration of pregabalin for more than 24 h before surgery was associated with maximal reductions in pain and opioid use at 72 h post-surgery.

Conclusion: Pregabalin was associated with significantly reduced postoperative pain and opioid use following total joint arthroplasty while enhancing mobility on the third day, with acceptable tolerability and safety.