SLR - February 2018 - Cathy T. Chuang
Reference: Sebastian B, Talikoti AT, Nelamangala K, Krishnamurthy D. Effect of Oral Pregabalin as Preemptive Analgesic in Patients Undergoing Lower-Limb Orthopaedic Surgeries Under Spinal Anesthesia. J Clin Diagn Res. 2016 Jul;10(7):UC01–4.Scientific Literature Review
Reviewed By: Cathy T. Chuang, DPM
Residency Program: Chino Valley Medical Center, Chino, CA
Podiatric Relevance: Postoperative pain has a significant impact on surgery outcomes due to many adverse effects, such as tachycardia, hypertension, ischemia, reduced alveolar ventilation, poor wound healing and patient discomfort. Conquering postoperative pain can be challenging for clinicians and has become a priority for practicing anesthesiologists and surgeons. Currently, a multimodal approach, including preemptive analgesia for treating postoperative pain that includes NSAIDs and opioids, is being implemented. More recently, GABA analogues like pregabalin and gabapentin are being used as preemptive analgesics. This study was to compare the efficacy of pregabalin 150 mg versus placebo for preemptive analgesia in patients undergoing elective lower-limb orthopaedic surgeries under spinal anesthesia and to assess any side effects.
Methods: A randomized double-blinded prospective study was undertaken. Ninety patients with ASA levels I and II between the ages of 18 and 50 years old were enrolled in the study. The study was done by the Department of Anesthesia at Sri Devaraj Urs Medical College in India for a duration of three months during June 2015 to September 2015. Exclusion criteria included patients with chronic pain, neurological disorders, patients on NSAIDs or other analgesics, known drug allergy to pregabalin or gabapentin, uncontrolled hypertension, diabetes mellitus, ischemic heart disease, cerebrovascular disease, renal and hepatic disease and history of alcohol and drug abuse. One hour prior to spinal anesthesia, Group C received a placebo and Group P received 150 mg of oral pregabalin. Rescue analgesia was provided with intramuscular Diclofenac 1.5 mg/kg. Patients were assessed every four hours for VAS score and for side effects, such as dizziness, sedation and blurred vision, for the first 24 hours postoperatively. An independent T-test was used to identify the mean difference between the two groups with a p-value set at <0.05 as statistically significant.
Results: Time for rescue analgesia (VAS score >3) was significantly longer in Group P (119.07 +/- 5.81 minutes) than in Group C (99.51 +/- 5.36 minutes). In addition, Group P experienced fewer times a VAS score > 3 was noted than Group C. The total dose of Diclofenac required in the 24-hour postoperative period was significantly lower in Group P (111.60 +/- 36.615 mg) than in Group C (177.91 +/1 39.694 mg). The sedation scores and patient satisfaction scores were also more in Group P than in Group C.
Conclusion: Preemptive analgesia with pregabalin offers effective postoperative analgesia, reducing the analgesic requirement and yields higher patient satisfaction levels in patients undergoing elective lower-limb orthopaedic surgery. Pregabalin can be an effective tool as a preemptive analgesic for the anesthesiologist in the management of perioperative pain.