The Effect Of The Use Of Pre-Emptive Oral Pregabalin On The Postoperative Spinal Analgesia In Patients Presented For Orthopedic Surgeries: Randomized Controlled Trial

Amany F Omara, Sameh A Ahmed, Motaz Ma Abusabaa, Amany F Omara, Sameh A Ahmed, Motaz Ma Abusabaa

Abstract

Background: Preoperative oral pregabalin could improve postoperative analgesia and prevent chronic pain development. The aim of this study is to evaluate the effect of oral pregabalin on the duration and quality of postoperative analgesia in spinal anesthesia.

Methods: Sixty adult patients presented for internal fixation of femoral fracture under spinal anesthesia were included in the study. They were randomly distributed to a placebo group and a pregabalin group receiving 150 mg pregabalin capsules 1 hr before surgery. The onset, duration, and regression of sensory and motor block were recorded. Rescue analgesia consumption, postoperative pain score, and quality of sleep were also assessed.

Results: Oral pregabalin significantly prolonged the time to two-segment regression of sensory block, reaching 86.67±17.88 mins, the time required to regression of spinal block to L2, reaching 155.33± 34.71 mins, and the duration of motor block, reaching 138 ± 23.5 mins, with no effect on the onset of sensory or motor block (P = 0.60 and 0.62). It significantly decreased the VAS score 4 hrs, 6 hrs, and 12 hrs postoperatively, prolonged the duration of postoperative analgesia, reaching 392.00±47.23 mins, and decreased morphine consumption to 7.67±3.65 mg. It also improved the quality of sleep in the first night after surgery.

Conclusion: Preemptive oral pregabalin prolonged the time to the first request for postoperative analgesics and improved sleep in the first night after surgery.

Keywords: motor; orthopedic; postoperative analgesia; pregabalin; randomized trial; sensory; spinal.

Conflict of interest statement

The authors declare no competing interests in this work.

© 2019 Omara et al.

Figures

Figure 1
Figure 1
CONSORT flow chart of the study.
Figure 2
Figure 2
The consensus sleep diary of the first night in the two groups. Data were presented as patients number. *Denotes significant change.

References

    1. Rathmell JP, Wu CL, Sinatra RS, et al. Acute post-surgical pain management: a critical appraisal of current practice. Reg Anesth Pain Med. 2006;31(4):1–42. doi:10.1016/j.rapm.2006.05.002
    1. Arcioni R, Palmisani S, Tigano S, et al. Combined intrathecal and epidural magnesium sulfate supplementation of spinal anesthesia to reduce post‐operative analgesic requirements: a prospective, randomized, double‐blind, controlled trial in patients undergoing major orthopedic surgery. Acta Anaesthesiol Scand. 2007;51(4):482–489. doi:10.1111/j.1399-6576.2007.01263.x
    1. Liu SS, Strodtbeck WM, Richman JM, Wu CL. A comparison of regional versus general anesthesia for ambulatory anesthesia: a meta-analysis of randomized controlled trials. Anesth Analg. 2005;101(6):1634–1642. doi:10.1213/01.ANE.0000180829.70036.4F
    1. Kaya FN, Yavascaoglu B, Turker G, et al. Intravenous dexmedetomidine, but not midazolam, prolongs bupivacaine spinal anesthesia. Can J Anaesth. 2010;57(1):39–45. doi:10.1007/s12630-009-9231-6
    1. Clarke H, Pagé GM, McCartney CJL, et al. Pregabalin reduces postoperative opioid consumption and pain for 1 week after hospital discharge, but does not affect function at 6 weeks or 3 months after total hip arthroplasty. Br J Anaesth. 2015;115(6):903–911. doi:10.1093/bja/aev363
    1. Akhavanakbari G, Entezariasl M, Isazadehfar K, Mirzarahimi T. The effects of oral pregabalin on post-operative pain of lower limb orthopedic surgery: a double-blind, placebo-controlled trial. Perspect Clin Res. 2013;4(3):165–168. doi:10.4103/2229-3485.115376
    1. Reuben SS, Buvanendran A. Preventing the development of chronic pain after orthopaedic surgery with preventive multimodal analgesic techniques. J Bone Joint Surg Am. 2007;89(6):1343–1358. doi:10.2106/00004623-200706000-00025
    1. Katz J, Clarke H, Seltzer ZE. Preventive analgesia: quo vadimus? Anesth Analg. 2011;113(5):1242–1253. doi:10.1213/ANE.0b013e31822c9a59
    1. Basavareddy A, Meher B, Rajendran I, Srinivasan S. Prospective, randomised, double blinded controlled trial of gabapentin and pregabalin as pre emptive analgesia in patients undergoing lower abdominal and limb surgery under spinal anaesthesia. Indian J Pain. 2014;28(3):155–159. doi:10.4103/0970-5333.138450
    1. Graham A, McClure J. Quantitative assessment of motor block in labouring women receiving epidural analgesia. Anaesthesia. 2001;56(5):470–476. doi:10.1046/j.1365-2044.2001.01524-6.x
    1. Carney CE, Buysse DJ, Ancoli-Israel S, et al. The consensus sleep diary: standardizing prospective sleep self-monitoring. Sleep. 2012;35(2):287–302. doi:10.5665/sleep.1642
    1. Ben-Menachem E. Pregabalin pharmacology and its relevance to clinical practice. Epilepsia. 2004;45(s6):13–18. doi:10.1111/j.0013-9580.2004.455003.x
    1. Cegin M, Soyoral L, Yuzkat N, Baydi V, Goktas U. Pregabalin administered as an anxiolytic agent in ultrasound-guided infraclavicular block: a controlled, double-blind, dose-ranging trial. Eur Rev Med Pharmacol Sci. 2016;20(3):568–574.
    1. Shimony N, Amit U, Minz B, et al. Perioperative pregabalin for reducing pain, analgesic consumption, and anxiety and enhancing sleep quality in elective neurosurgical patients: a prospective, randomized, double-blind, and controlled clinical study. J Neurosurg. 2016;125(6):1513–1522. doi:10.3171/2015.10.JNS151516
    1. Tiippana EM, Hamunen K, Kontinen VK, Kalso E. Do surgical patients benefit from perioperative gabapentin/pregabalin? A systematic review of efficacy and safety. Anesth Analg. 2007;104(6):1545–1556. doi:10.1213/01.ane.0000261517.27532.80
    1. Buvanendran A, Kroin JS, Kari M, Tuman KJ. Can a single dose of 300 mg of pregabalin reach acute antihyperalgesic levels in the central nervous system? Reg Anesth Pain Med. 2010;35(6):535–538. doi:10.1097/AAP.0b013e3181fa6b7a
    1. Bafna U, Rajarajeshwaran K, Khandelwal M, Verma A. A comparison of effect of preemptive use of oral gabapentin and pregabalin for acute post-operative pain after surgery under spinal anesthesia. J Anaesthesiol Clin Pharmacol. 2014;30(3):373. doi:10.4103/0970-9185.137270
    1. Park M, Jeon Y. Preoperative pregabalin prolongs duration of spinal anesthesia and reduces early postoperative pain: a double-blind, randomized clinical CONSORT study. Medicine. 2016;95(36). doi:10.1097/MD.0000000000004864
    1. Short J, Downey K, Bernstein P, Shah V, Carvalho JCA. A single preoperative dose of gabapentin does not improve postcesarean delivery pain management: a randomized, double-blind, placebo-controlled dose-finding trial. Surv Anesthesiol. 2013;57(4):186–187. doi:10.1097/01.sa.0000431212.11836.26
    1. Monks DT, Hoppe DW, Downey K, Shah V, Bernstein P, Carvalho JCA. A perioperative course of gabapentin does not produce a clinically meaningful improvement in analgesia after cesarean delivery. A randomized controlled trial. Anesthesiology. 2015;123(2):320–326. doi:10.1097/ALN.0000000000000722

Source: PubMed

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