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Axelby E, Kurmis AP. Gabapentoids in knee replacement surgery: contemporary, multi-modal, peri-operative analgesia. J Orthop. 2019;17:150-154doi: 10.1016/j.jor.2019.06.031.
Axelby, E., & Kurmis, A. P. (2020). Gabapentoids in knee replacement surgery: contemporary, multi-modal, peri-operative analgesia. Journal of orthopaedics, 17150-154. https://doi.org/10.1016/j.jor.2019.06.031
Axelby, Evelyn, and Kurmis, Andrew P. "Gabapentoids in knee replacement surgery: contemporary, multi-modal, peri-operative analgesia." Journal of orthopaedics vol. 17 (2020): 150-154. doi: https://doi.org/10.1016/j.jor.2019.06.031
Axelby E, Kurmis AP. Gabapentoids in knee replacement surgery: contemporary, multi-modal, peri-operative analgesia. J Orthop. 2019 Jul 02;17:150-154. doi: 10.1016/j.jor.2019.06.031. eCollection 2020. PMID: 31879495; PMCID: PMC6919380.
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J Orthop. 2019 Jul 02;17:150-154. doi: 10.1016/j.jor.2019.06.031. eCollection 2020.

Gabapentoids in knee replacement surgery: contemporary, multi-modal, peri-operative analgesia.

Journal of orthopaedics

Evelyn Axelby, Andrew P Kurmis

Affiliations

  1. School of Medicine, Division of Health Sciences, University of Adelaide, Adelaide, Australia.
  2. Staff Specialist & Consultant Orthopaedic Surgeon, University of Adelaide, School of Medical Specialties, Adelaide, Australia.

PMID: 31879495 PMCID: PMC6919380 DOI: 10.1016/j.jor.2019.06.031

Abstract

Pain remains a significant barrier to rapid patient recovery and rehabilitation post-surgery, particularly after joint replacement surgery. Historically, protocols used for peri-operative pain management have been largely reactive and dependent on opioid use, with adjunctive non-steroidal and other simple analgesia. This review explores the evidence supporting the use of gabapentoids (eg. Lyrica®) in surgical fields, then in orthopaedics more specifically, and finally in the targeted domain of total knee replacement (TKR) surgery. The concept of 'pre-emptive' analgesia is also explored. Gabapentoids have shown clinical value in reducing the patient-reported pain experience and also decreasing concurrent opioid requirements in the post-surgical period in a number of surgical areas, however there remains no consensus for their optimal use in patients undergoing knee arthroplasty. Reported adverse effects including sedation and potential respiratory depression should herald some caution, and monitored use in 'at risk' patient groups. There have been a small number of clinical trials conducted around the use of gabapentoids in TKR, however the validity and generalisability of these results have been limited by small sample sizes, and cross-study analysis is confounded by adoption of inconsistent analgesic protocols, non-comparable dosing regimes, poor (or absent) control selection, and cohort heterogeneity. High-quality trials are needed to allow the role of gabapentoids in multi-modal peri-operative analgesic pathways to be better defined, to permit wider endorsement for main-stream or standardised care.

© 2019 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights reserved.

Keywords: Analgesics; Arthroplasty; Gabapentoids; Knee; Lyrica; Opioid; Orthopaedics; Pain management; Replacement; Total knee replacement

References

  1. Obes Surg. 2010 Dec;20(12):1678-81 - PubMed
  2. Geriatr Orthop Surg Rehabil. 2010 Sep;1(1):5 - PubMed
  3. Pain Res Manag. 2009 May-Jun;14(3):217-22 - PubMed
  4. J Clin Diagn Res. 2016 Jul;10(7):UC01-4 - PubMed
  5. Pain Res Treat. 2018 Aug 7;2018:3807217 - PubMed
  6. Br J Anaesth. 2010 Aug;105(2):155-61 - PubMed
  7. J Oral Maxillofac Surg. 2012 Jan;70(1):25-30 - PubMed
  8. J Clin Pharmacol. 2010 Aug;50(8):941-50 - PubMed
  9. Medicine (Baltimore). 2017 Sep;96(37):e8031 - PubMed
  10. Br J Anaesth. 2015 Dec;115(6):903-11 - PubMed
  11. Anesthesiology. 1996 May;84(5):1015-9 - PubMed
  12. Perspect Clin Res. 2013 Jul;4(3):165-8 - PubMed
  13. Singapore Med J. 2007 Aug;48(8):748-51 - PubMed
  14. Acta Anaesthesiol Scand. 2011 May;55(5):571-6 - PubMed
  15. Pain. 2015 Jul;156(7):1284-300 - PubMed
  16. Psychopharmacology (Berl). 2005 Dec;183(2):133-43 - PubMed
  17. Pain. 2004 May;109(1-2):26-35 - PubMed
  18. J Pain Res. 2014 Dec 23;8:9-20 - PubMed
  19. J Clin Anesth. 2016 Jun;31:149-53 - PubMed
  20. Neurology. 2003 Apr 22;60(8):1274-83 - PubMed
  21. Br J Anaesth. 2015 Jan;114(1):10-31 - PubMed
  22. Spine (Phila Pa 1976). 2013 Oct 15;38(22):1947-52 - PubMed
  23. Br J Anaesth. 2014 Nov;113(5):855-64 - PubMed
  24. J Arthroplasty. 2010 Apr;25(3):410-5 - PubMed
  25. Anesth Essays Res. 2016 May-Aug;10(2):262-7 - PubMed
  26. Medicine (Baltimore). 2015 Nov;94(46):e1944 - PubMed
  27. Br J Anaesth. 2011 Apr;106(4):454-62 - PubMed
  28. Acta Anaesthesiol Scand. 2011 Sep;55(8):927-43 - PubMed
  29. Anesth Analg. 2003 Aug;97(2):534-40, table of contents - PubMed
  30. Medicine (Baltimore). 2017 Jun;96(26):e6947 - PubMed
  31. Anesth Pain Med. 2012 Fall;2(2):72-6 - PubMed
  32. Medwave. 2017 Dec 27;17(9):e7115 - PubMed
  33. Neurology. 2003 May 27;60(10):1631-7 - PubMed
  34. J Psychopharmacol. 2011 Feb;25(2):249-53 - PubMed
  35. Ann Pharmacother. 2005 Dec;39(12):2029-37 - PubMed
  36. Anesth Analg. 2007 Nov;105(5):1449-53, table of contents - PubMed
  37. J Bone Joint Surg Am. 2016 Aug 17;98(16):1340-50 - PubMed
  38. Pain Res Treat. 2014;2014:850794 - PubMed
  39. J Arthroplasty. 2015 Jan;30(1):38-42 - PubMed
  40. Br J Anaesth. 2012 May;108(5):845-9 - PubMed
  41. Pain. 2004 Aug;110(3):628-38 - PubMed
  42. Br J Anaesth. 2015 Aug;115(2):285-93 - PubMed
  43. Reg Anesth Pain Med. 2012 May-Jun;37(3):302-7 - PubMed
  44. Iran J Pharm Res. 2018 Winter;17(Suppl):2-7 - PubMed
  45. J Pain Res. 2013 Jun 24;6:471-8 - PubMed
  46. Br J Anaesth. 2008 Jun;100(6):834-40 - PubMed
  47. Anesthesiology. 2008 Dec;109(6):1077-84 - PubMed
  48. Anesth Analg. 2010 Jan 1;110(1):199-207 - PubMed
  49. Eur Neuropsychopharmacol. 2006 Jul;16 Suppl 2:S128-33 - PubMed
  50. J Bone Joint Surg Am. 2007 Nov;89(11):2532-5 - PubMed
  51. Epilepsia. 2004;45 Suppl 6:13-8 - PubMed
  52. J Med Assoc Thai. 2009 Oct;92(10):1318-23 - PubMed
  53. J Neurosci Res. 2008 Nov 15;86(15):3258-64 - PubMed
  54. J Clin Psychopharmacol. 2003 Jun;23(3):240-9 - PubMed
  55. Anesth Analg. 2005 May;100(5):1394-9, table of contents - PubMed
  56. Clin Oral Investig. 2018 Jan;22(1):119-129 - PubMed
  57. Anesth Analg. 2002 Sep;95(3):627-34, table of contents - PubMed
  58. Anesthesiology. 2007 Mar;106(3):557-62 - PubMed
  59. Int J Surg. 2016 Oct;34:148-160 - PubMed
  60. J Clin Anesth. 2012 May;24(3):175-8 - PubMed
  61. Arthritis Rheum. 2005 Apr;52(4):1264-73 - PubMed
  62. Br J Anaesth. 2008 Oct;101(4):535-41 - PubMed

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