Analgesic Efficacy and Side Effects of Low-Dose Pregabalin As a Modern Multimodal Agent for Postoperative Pain Control After Total Knee Arthroplasty: A Prospective, Double-Blinded, Randomized Controlled Trial.

BACKGROUND

Pregabalin is an essential component of contemporary multimodal analgesic strategies for managing postoperative pain after total knee arthroplasty (TKA). The current recommendation is a daily dosage of 150 to 300 mg for 14 days postoperatively. Reported side effects include dizziness and sedation. Our study aimed to investigate the analgesic efficacy and side effects of low-dose pregabalin (75 mg) compared with the recommended 150 mg dose.

METHODS

We conducted a double-blinded, randomized controlled trial in patients undergoing unilateral primary TKA to compare the efficacy of postoperative pregabalin at 75 versus 150 mg daily for 14 days. All patients received intraoperative corticosteroids, spinal anesthesia, adductor canal block, pericapsular injection, and other standardized medications. The primary outcome was pain, assessed using the visual analog scale at rest and during motion at 24, 48 hours, and at two, six, and 12 weeks postoperatively. Secondary outcomes included morphine consumption, adverse events, time to ambulation, knee flexion, Knee Society Scores, the Two-Minute Walking Test, and the Timed Up-and-Go Test.

RESULTS

Our results revealed no statistically significant difference in visual analog scale scores between the 75 and 150 mg groups at various time points up to 12 weeks postsurgery. However, the 75 mg group exhibited substantially lower incidences of dizziness (17 versus 61% in the 150 mg group, P < 0.001) and faster time to ambulation (27 ± four versus 30 ± four hours in the 150 mg group, P < 0.001). Other outcome measures showed no notable variances between the two groups.

CONCLUSIONS

A 75 mg dosage of pregabalin for 14 days post-TKA provided pain control similar to 150 mg, with additional benefits of faster ambulation and reduced dizziness. Therefore, we advocate for the use of 75 mg pregabalin as part of a contemporary multimodal analgesic regimen for postoperative pain management after TKA, particularly in the growing trend of outpatient TKA.

LEVEL OF EVIDENCE: Therapeutic level I.