Kjær Petersen Kristian, Lunn Troels Haxholdt, Husted Henrik, Hansen Lars Tambour, Simonsen Ole, Laursen Mogens Berg, Kehlet Henrik, Arendt-Nielsen Lars
SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Fredrik Bajers Vej 7 D3, DK-9220 Aalborg, Denmark, Phone: +45 9940 7529, Fax: +45 9815 4008.
The Lundbeck Centre for Fast-track Hip and Knee Arthroplasty, Copenhagen, Denmark.
Scand J Pain. 2018 Apr 25;18(2):237-245. doi: 10.1515/sjpain-2018-0027.
Approximately 20% of patients having total knee arthroplasty (TKA) will experience chronic postoperative pain. Recently, preoperative pain facilitation has been associated with chronic pain after TKA, and gabapentin has been shown to decrease pain facilitation. The current study is a secondary follow-up of a primary RCT investigating the effect of gabapentin on acute postoperative pain after TKA and exploring the effect of pre- and perioperative administration of gabapentin on chronic postoperative pain and psychological state 3-4 years after TKA.
Patients scheduled for TKA were randomized to either gabapentin 1,300 mg/day, gabapentin 900 mg/day, or placebo daily from 2-h before and 6 days after operation. Pre- and 3-4 years postoperatively pain scores related to pain while walking, at rest, when flexing the hip or the knee were collected. At the same time, the pain catastrophizing scale (PCS) and hospital anxiety and depression scale subscales for anxiety (HADS-A) and depression (HADS-D) were collected.
Lower postoperative pain while walking, flexing the hip, and at rest were found compared with preoperative scores (p<0.03), but these were not associated with gabapentin treatment (p>0.19). Significantly lower postoperative PCS and HADS-A scores were seen compared with preoperative scores (p<0.001), but these were not associated with gabapentin treatment (p>0.55).
The current study found that pre- and perioperative administrations of gabapentin do not influence the pain or psychological state 3-4 years after TKA.
The current study does not support that short-term pre- and perioperative use of gabapentin can reduce the development of chronic postoperative pain after TKA.
全膝关节置换术（TKA）患者中约20%会经历慢性术后疼痛。近期，术前疼痛易化与TKA术后慢性疼痛相关，且已证实加巴喷丁可减轻疼痛易化。本研究是一项主要随机对照试验（RCT）的二次随访，该RCT研究了加巴喷丁对TKA术后急性疼痛的影响，并探讨了术前及围手术期给予加巴喷丁对TKA术后3 - 4年慢性疼痛和心理状态的影响。
计划接受TKA的患者在术前2小时至术后6天被随机分为每日服用1300毫克加巴喷丁组、每日服用900毫克加巴喷丁组或安慰剂组。收集术前及术后3 - 4年与行走、休息、屈髋或屈膝时疼痛相关的疼痛评分。同时，收集疼痛灾难化量表（PCS）以及医院焦虑抑郁量表焦虑分量表（HADS - A）和抑郁分量表（HADS - D）。
与术前评分相比，术后行走、屈髋和休息时的疼痛降低（p<0.03），但这些与加巴喷丁治疗无关（p>0.19）。与术前评分相比，术后PCS和HADS - A评分显著降低（p<0.001），但这些与加巴喷丁治疗无关（p>0.55）。
本研究发现，术前及围手术期给予加巴喷丁对TKA术后3 - 4年的疼痛或心理状态无影响。
本研究不支持短期术前及围手术期使用加巴喷丁可减少TKA术后慢性疼痛的发生。
