Combined treatment (Norspan, Gabapentin and Oxynorm) was found superior in pain management after total knee arthroplasty.

Background Gabapentin (GAB) has recently been introduced for postoperative pain treatment in orthopedic surgery. As persistent postoperative pain is still a major problem in total knee arthroplasty (TKA), studies on the effect and side effects of Gabapentin in addition to the commonly used morphine (MOR), Oxynorm (OXY) and Norspan (NOR) are highly warranted. In the present study, four relevant treatment algorithms, gabapentin and morphine (GAB/MOR), gabapentin and Oxynorm (GAB/OXY), Oxynorm (OXY) and Gabapentin, Oxynorm and Norspan (GAB/OXY/NOR) were examined. Patients and methods A total of 241 patients were followed systematically during one month following TKA in four consecutive series: 60 patients were treated with GAB/MOR, 62 patients with GAB/OXY, 59 patients with OXY, and 60 patients with GAB/OXY/MOR. On the day before surgery and on postoperative day 1, 14, and 30, pain during rest, pain during walking and side effects (constipation, dizziness, and nausea) were reported (VAS). Results After 30 days, pain greatly decreased in all groups, with a superior effect of GAB/OXY/NOR for pain during rest and only slightly more side effects at day 1. Conclusions In management of postoperative pain following TKA, data indicated that GAB/OXY/NOR was superior, compared to GAB/MOR, GAB/OXY, and OXY.