Efficacy of Preemptive Oral Pregabalin in Reduction of Acute Postoperative Pain in Patients Undergoing Total Knee Arthroplasty in a Tertiary Care Hospital in Chengalpattu District: A Double Blind Randomised Controlled Trial

Abstract

Background: Effective postoperative pain control is essential for recovery and functional improvement after Total Knee Arthroplasty (TKA), a procedure often associated with severe pain. Although opioids are commonly used, their adverse effects—such as nausea, vomiting, sedation, and dependence—limit their use. Pregabalin, a Gabapentinoid with analgesic and antihyperalgesic properties, is emerging as a promising preemptive agent in multimodal analgesia.

Objectives: This study evaluates the efficacy of preemptive oral Pregabalin in reducing acute postoperative pain and opioid requirements in TKA patients. Secondary objectives include assessing time to first breakthrough analgesia, patient satisfaction, and adverse effects.

Methodology: A double-blind randomised controlled trial was conducted at a tertiary care hospital in Chengalpattu, Tamil Nadu. 128 patients scheduled for elective TKA were randomised into two groups: one received 150 mg oral Pregabalin 6 hours preoperatively, the other received a placebo. All patients underwent standard regional anaesthesia. Pain was assessed using the Visual Analogue Scale (VAS) at intervals of up to 48 hours postoperatively, both at rest and during movement. Secondary measures included time first to rescue analgesia, total analgesic requirement, incidence of postoperative nausea and vomiting (PONV), side effects, and patient satisfaction.

Results: VAS scores were significantly lower in the Pregabalin group at all time points (p < 0.001). Time to first analgesia was longer (8.5 vs. 4 hours), with reduced opioid use and lower PONV. Mild sedation and dizziness were more common but not clinically significant. Satisfaction scores were higher on postoperative days 1 and 2.

Conclusion: Preemptive Pregabalin significantly improves postoperative pain control, reduces opioid-related side effects, and enhances patient satisfaction after TKA.