Effect of Pregabalin on Preoperative Anxiety and Postoperative Pain in Spine Surgery: A Randomized Controlled StudySupported by: None
09 February 2018 (online)
Background Pregabalin is a gabapentinoid which has been shown to possess analgesic and anxiolytic properties. The present study aimed to assess the efficacy of a single dose of pregabalin on postoperative pain and preoperative anxiety in patients undergoing lumbar spine surgery.
Materials and Methods Sixty adults posted for elective lumbar laminectomy and discectomy were randomly assigned to one of the three groups; Group C received placebo capsules, Group PI received pregabalin 150 mg, and Group P2 received pregabalin 300 mg capsules, 2 h prior to induction of anesthesia. The levels of anxiety and pain were assessed with respective 100 mm visual analog scale (VAS) score. Postoperative fentanyl consumption and occurrence of side effects were recorded. All patients were observed for 8 h, postoperatively.
Results There was a significant reduction in preoperative anxiety in both pregabalin groups as compared to control group (p = 0.001). VAS score for pain (at rest and during movement) was significantly decreased at all time intervals in both PI and P2 groups as compared to control (p < 0.05). Fentanyl consumption in the postoperative period was significantly reduced in pregabalin groups as compared to control (p = 0.001). The level of sedation was higher in P2 group in the first 4 h (p < 0.05). The occurrence of postoperative nausea and vomiting was more in control group as compared to the pregabalin groups (p = 0.018). The incidence of dizziness and blurring of vision was significantly more in P2 group.
Conclusion Single preoperative dose of pregabalin 150 or 300 mg was effective in reducing preoperative anxiety, postoperative pain and total fentanyl consumption in patients undergoing lumbar laminectomy and discectomy. However, the incidence of postoperative side effects such as sedation, dizziness and visual blurring was more in patients who received pregabalin 300 mg.
- 1 Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: Results from a national survey suggest postoperative pain continues to be undermanaged.. Anesth Analg 2003; 97: 534-540
- 2 Perkins FM, Kehlet H. Chronic pain as an outcome of surgery. A review of predictive factors.. Anesthesiology 2000; 93: 1123-33
- 3 Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome.. Am J Surg 2002; 183: 630-641
- 4 Kehlet H, Dahl JB. The value of “multimodal” or “balanced analgesia” in postoperative pain treatment.. Anesth Analg 1993; 77: 1048-1056
- 5 White PF. Multimodal analgesia: Its role in preventing postoperative pain.. Curr Opin Investig Drugs 2008; 9: 76-82
- 6 Woolf CJ, Chong MS. Preemptive analgesia - Treating postoperative pain by preventing the establishment of central sensitization.. Anesth Analg 1993; 77: 362-379
- 7 Werner MU, Perkins FM, Holte K, Pedersen JL, Kehlet H. Effects of gabapentin in acute inflammatory pain in humans.. Reg Anesth Pain Med 2001; 26: 322-328
- 8 Shneker BF, McAuley JW. Pregabalin: A new neuromodulator with broad therapeutic indications.. Ann Pharmacother 2005; 39: 2029-2037
- 9 Lauria-Horner BA, Pohl RB. Pregabalin: A new anxiolytic.. In-vestig Drugs 2003; 12: 663-672
- 10 Dolin SJ, Cashman JN. Tolerability of acute postoperative pain management: Nausea, vomiting, sedation, pruritus, and urinary retention. Evidence from published data.. Br J Anaesth 2005; 95: 584-591
- 11 Crofford LJ, Oates JC, McCune WJ, Gupta S, Kaplan MJ, Catella-Lawson F. et al. Thrombosis in patients with connective tissue diseases treated with specific cyclooxygenase 2 inhibitors. A report of four cases.. Arthritis Rheum 2000; 43: 1891-1896
- 12 Reuben SS, Buvanendran A, Kroin JS, Raghunathan K. The analgesic efficacy of celecoxib, pregabalin, and their combination for spinal fusion surgery.. Anesth Analg 2006; 103: 1271-1277
- 13 Mathiesen O, Jacobsen LS, Holm HE, Randall S, Adamiec-Malm-stroem L, Graungaard BK. et al. Pregabalin and dexamethasone for postoperative pain control: A randomized controlled study in hip arthroplasty.. Br J Anaesth 2008; 101: 535-541
- 14 Jokela R, Ahonen J, Tallgren M, Haanpää M, Korttila K. Premedication with pregabalin 75 or 150 mg with ibuprofen to control pain after day-case gynaecological laparoscopic surgery.. Br J Anaesth 2008; 100: 834-840
- 15 Agarwal A, Gautam S, Gupta D, Agarwal S, Singh PK, Singh U. Evaluation of a single preoperative dose of pregabalin for attenuation of postoperative pain after laparoscopic cholecystectomy.. Br J Anaesth 2008; 101: 700-704
- 16 Sarakatsianou C, Theodorou E, Georgopoulou S, Stamatiou G, Tzovaras G. Effect of pre-emptive pregabalin on pain intensity and postoperative morphine consumption after laparoscopic cholecystectomy.. Surg Endosc 2013; 27: 2504-2511
- 17 White PF, Tufanogullari B, Taylor J, Klein K. The effect of pregabalin on preoperative anxiety and sedation levels: A dose-ranging study.. Anesth Analg 2009; 108: 1140-1145
- 18 Mathiesen O, Rasmussen ML, Dierking G, Lech K, Hilsted KL, Fomsgaard JS. et al. Pregabalin and dexamethasone in combination with paracetamol for postoperative pain control after abdominal hysterectomy. A randomized clinical trial.. Acta Anaesthesiol Scand 2009; 53: 227-235
- 19 Peng PW, Li C, Farcas E, Haley A, Wong W, Bender J. et al. Use of low-dose pregabalin in patients undergoing laparoscopic cholecystectomy.. Br J Anaesth 2010; 105: 155-161
- 20 Kavoussi R. Pregabalin: From molecule to medicine.. Eur Neuropsychopharmacol 2006; 162: S128-S133