pregabalin and Pain--Postoperative

Pregabalin supplementation may have some potential in improving pain relief in patients with septorhinoplasty, and this meta-analysis aims to explore the impact of pregabalin supplementation on pain control for septorhinoplasty.. PubMed, EMbase, Web of science, EBSCO and Cochrane library databases were systematically searched, and we included randomized controlled trials (RCTs) assessing the effect of pregabalin supplementation on pain control for septorhinoplasty.. Six RCTs were finally included in the meta-analysis. Overall, when compared with control intervention for septorhinoplasty, pregabalin intervention showed significantly reduced pain scores at 1 h (SMD - 1.05; 95% CI - 1.85 to - 0.24; P = 0.01), 2 h (SMD - 1.01; 95% CI - 1.83 to - 0.20; P = 0.02), 6 h (SMD - 1.00; 95% CI - 1.47 to - 0.54; P < 0.0001) and 12 h (SMD - 0.69; 95% CI - 1.35 to - 0.02; P = 0.04), as well as rescue analgesics (OR 0.17; 95% CI 0.07 to 0.44; P = 0.0002), but had no notable influence on nausea and vomiting (OR 0.67; 95% CI 0.30 to 1.46; P = 0.31), or drowsiness (OR 1.22; 95% CI 0.64 to 2.35; P = 0.54).. Pregabalin supplementation benefits to pain control after septorhinoplasty.

Topics: Analgesics; Dietary Supplements; Humans; Pain Management; Pain, Postoperative; Pregabalin

In recent years, there has been increased interest in using gabapentinoids (gabapentin and pregabalin) as part of multimodal medication plans or enhanced recovery after surgery protocols to mitigate several perioperative clinical challenges. Outcomes explored in the context of using gabapentinoids perioperatively in children are variable and include acute complications of pain, anxiety, nausea and vomiting, and emergence agitation, as well as the long-term postoperative outcome of chronic postsurgical pain. This narrative review describes the current literature regarding perioperative use of gabapentinoids in pediatric patients and aims to describe the role of gabapentinoids in the perioperative setting for each specific indication.

Topics: Analgesics; Child; Gabapentin; Humans; Pain, Postoperative; Pregabalin

To evaluate the efficacy of perioperative gabapentin or pregabalin treatment on postoperative pain and opioid requirement reduction in patients undergoing anterior cruciate ligament reconstruction (ACLR).. A systematic review of randomized control trials was conducted evaluating the effect of gabapentin or pregabalin on postoperative pain and opioid requirement for patients undergoing ACLR. The primary outcomes assessed were postoperative pain scores and opioid requirements. Secondary outcomes were complications, side effects, dosage, and timing of intervention.. The initial search query identified 151 studies and 6 studies were included after full-text articles were reviewed. Three studies investigated the use of gabapentin and three studies investigated pregabalin. All three gabapentin studies reported significantly decreased or equivalent pain scores while also significantly reducing or removing total opioid consumption compared to control groups. Pregabalin demonstrated inconsistent efficacy for pain control and opioid consumption parameters across three studies. One study (pregabalin, n = 1) reported significantly increased incidence of dizziness with pregabalin compared to placebo.. There is moderate evidence demonstrating that preoperative gabapentin may be safe and effective in reducing postoperative pain and opioid consumption after ACLR. Gabapentin may be considered when employed as part of a multimodal analgesia regimen; however, the optimal protocol has yet to be determined. Currently, there is limited evidence demonstrating the efficacy of pregabalin on pain and opioid consumption in the setting of ACLR.. Level I, systematic review of Level I Studies.

Topics: Analgesics; Analgesics, Opioid; Anterior Cruciate Ligament Reconstruction; Gabapentin; Humans; Pain, Postoperative; Pregabalin; Randomized Controlled Trials as Topic

The pregabalin is approved for the management of persistent pain. The aim of this study is to assess the advantages and disadvantages of the use of pregabalin in eye pain management.. The PubMed, Cochrane Library, Embase, and Web of Science databases were searched until January 2022 for randomized controlled trials. Randomized, double-blinded trials comparing pregabalin with placebo in eye pain management were included. The primary outcome was visual analog scale or numerical rating scale at acute (24 hours) and chronic (≥7 days after surgery) timepoints. The secondary outcomes were analgesic medication requirements and pregabalin-related complications (nausea, vomiting, dizziness, and headache). We also compared the effect of pregabalin on dry-eye syndrome.. Six relevant articles were identified that studied the use of pregabalin as pain relief for photorefractive keratectomy (n = 2), laser epithelial keratomileusis (n = 1), laser-assisted in situ keratomileusis (n = 1), eyelid surgery (n = 1), and dacryocystorhinostomy (n = 1). Pregabalin was associated with a significant reduction in pain scores (95% confidence interval = -0.41 [-0.76--0.06]) 24 hours after surgical procedures. The data were insufficient to draw conclusions regarding dry eye symptoms. Because of the high heterogeneity of outcomes regarding adverse effects, there is no conclusion regarding the safety of pregabalin in eye pain.. Pregabalin reduced acute eye pain but had no significant effect on long-term analgesia after ophthalmological surgery in adults. It had no effect on dry-eye symptoms after ocular surgery. Further studies on the safety of pregabalin in eye pain management are required to draw solid conclusions.

Topics: Acute Pain; Adult; Analgesia; Analgesics; Eye Pain; Humans; Pain, Postoperative; Pregabalin

Topics: Analgesics; Analgesics, Opioid; Humans; Morphine; Neoplasms; Pain, Postoperative; Pregabalin

The analgesic efficacy of pregabalin supplementation for septorhinoplasty remains elusive. This meta-analysis was conducted to compare pregabalin supplementation with placebo for the postoperative pain control of septorhinoplasty.. We systematically searched several databases including PubMed, EMbase, Web of Science, EBSCO and Cochrane library databases, and included randomized controlled trials (RCTs) regarding the effect of pregabalin supplementation versus placebo for pain control after septorhinoplasty. This meta-analysis was conducted by fixed or random-effect model based on the heterogeneity.. Seven RCTs were included in this meta-analysis. In comparison with control group for septorhinoplasty, pregabalin supplementation was associated with significantly decreased pain scores at 1 h (standard mean difference [SMD] = -1.45; 95% confidence interval [CI] = -2.43 to -0.47; P = .004), pain scores at 2 hours (SMD = -1.01; 95% CI = -1.83 to -0.20; P = .02), pain scores at 6 hours (SMD = -1.00; 95% CI = -1.47 to -0.54; P < .0001), number of rescue analgesics (odd ratio [OR] = 0.18; 95% CI = 0.08-0.39; P < .0001) and analgesic consumption (SMD = -2.78; 95% CI = -5.05 to -0.51; P = .02), but unraveled no obvious impact on the incidence of nausea and vomiting (OR = 0.55; 95% CI = 0.24-1.27; P = .16).. Pregabalin supplementation was effective to improve pain relief after septorhinoplasty.

Topics: Analgesics; Humans; Pain Management; Pain, Postoperative; Pregabalin; Vomiting

Patients undergoing spine surgery often experience severe pain. The optimal dosage of pregabalin and gabapentin for pain control and safety in these patients has not been well established.. To evaluate the associations of pain, opioid consumption, and adverse events with different dosages of pregabalin and gabapentin in patients undergoing spine surgery.. PubMed/MEDLINE, Embase, Web of Science, Cochrane library, and Scopus databases were searched for articles until August 7, 2021.. Randomized clinical trials conducted among patients who received pregabalin or gabapentin while undergoing spine surgery were included.. Two investigators independently performed data extraction following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) reporting guideline. The network meta-analysis was conducted from August 2022 to February 2023 using a random-effects model.. The primary outcome was pain intensity measured using the Visual Analog Scale (VAS), and secondary outcomes included opioid consumption and adverse events.. Twenty-seven randomized clinical trials with 1861 patients (median age, 45.99 years [range, 20.00-70.00 years]; 759 women [40.8%]) were included in the systematic review and network meta-analysis. Compared with placebo, the VAS pain score was lowest with gabapentin 900 mg per day, followed by gabapentin 1200 mg per day, gabapentin 600 mg per day, gabapentin 300 mg per day, pregabalin 300 mg per day, pregabalin 150 mg per day, and pregabalin 75 mg per day. Additionally, gabapentin 900 mg per day was found to be associated with the lowest opioid consumption among all dosages of gabapentin and pregabalin, with a mean difference of -22.07% (95% CI, -33.22% to -10.92%) for the surface under the cumulative ranking curve compared with placebo. There was no statistically significant difference in adverse events (nausea, vomiting, and dizziness) among all treatments. No substantial inconsistency between direct and indirect evidence was detected for all outcomes.. These findings suggest that gabapentin 900 mg per day before spine surgery is associated with the lowest VAS pain score among all dosages. In addition, no differences in adverse events were noted among all treatments.

Topics: Analgesics; Analgesics, Opioid; Female; Gabapentin; Humans; Middle Aged; Network Meta-Analysis; Pain, Postoperative; Pregabalin

In an attempt to aggregate observations from clinical trials, several meta-analyses have been published examining the effectiveness of systemic, non-opioid, pharmacological interventions to reduce the incidence of chronic postsurgical pain.. To inform the design and reporting of future studies, the purpose of our study was to examine the quality of these meta-analyses.. We conducted an electronic literature search in Embase, MEDLINE, and the Cochrane Database of Systematic Reviews. Published meta-analyses, from the years 2010 to 2020, examining the effect of perioperative, systemic, non-opioid pharmacological treatments on the incidence of chronic postsurgical pain in adult patients were identified. Data extraction focused on methodological details. Meta-analysis quality was assessed using the A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) critical appraisal tool.. Our search yielded 17 published studies conducting 58 meta-analyses for gabapentinoids (gabapentin and pregabalin), ketamine, lidocaine, non-steroidal anti-inflammatory drugs, and mexiletine. According to AMSTAR 2, 88.2% of studies (or 15/17) were low or critically low in quality. The most common critical element missing was an analysis of publication bias. Trends indicated an improvement in quality over time and association with journal impact factor.. With few individual trials adequately powered to detect treatment effects, meta-analyses play a crucial role in informing the perioperative management of chronic postsurgical pain. In light of this inherent value and despite a number of attempts, high-quality meta-analyses are still needed.. CRD42021230941.

Topics: Adult; Chronic Pain; Gabapentin; Humans; Ketamine; Pain, Postoperative; Pregabalin

This review summarizes the risks and benefits of gabapentinoids (gabapentin and pregabalin) for perioperative pain control and the controversies surrounding their use in a variety of settings. We review current literature with the goal of providing patient-centric and procedure-specific recommendations for the use of these medications.. Gabapentinoids are among the most prescribed medications in the USA, and typically for off-label indications such as postoperative pain. In the perioperative setting, multimodal analgesic or "opioid-sparing" regimens have become the standard of care-and some clinical protocols include gabapentinoids. At the same time, guidelines regarding the perioperative use of gabapentinoids are conflicting and evidence supporting their broad use is lacking. Gabapentinoids administered perioperatively reduce opioid requirements and pain scores for a variety of surgeries. The extent of opioid and pain reduction, however, is not always clinically significant. These medications reduce postoperative nausea and vomiting as well as pruritis, likely as a feature of reducing opioid intake, but are associated with side effects such as dizziness, ataxia, and cognitive dysfunction. Gabapentinoids also increase the risk of respiratory depression, in particular when paired with opioids. There is thus evidence suggesting that the routine use of these medications for perioperative pain management is not recommended. An individualized, patient- and surgery-specific approach should be used, although research is still needed to determine risks and benefits during perioperative use.

Topics: Analgesics; Analgesics, Opioid; Gabapentin; Humans; Pain, Postoperative; Perioperative Care; Pregabalin

Catheter-related bladder discomfort (CRBD) is a common complication of intraoperative urinary catheterization. Various studies have evaluated the efficacy of different interventions in postoperative CRBD. The present review was performed to assess the efficacy of these interventions.. PubMed, Embase, and CENTRAL (Cochrane Central Register of Controlled Trials) databases were systematically searched to identify randomized controlled trials (RCTs) investigating the efficacy of different drugs for the prevention of postoperative CRBD. This review evaluated the incidence and severity of CRBD after different interventions at 0, 1, 2, and 6 h postoperatively.. Forty-five studies including 31 different drugs were analyzed. Eleven drugs were investigated in more than two RCTs, of which dexmedetomidine, gabapentin, tolterodine, tramadol, ketamine, nefopam, oxybutynin, pregabalin, and pudendal nerve block (PNB) generally showed significantly higher efficacy than controls postoperatively. Solifenacin only showed significant efficacy compared with the control at 0 h, and intravenous lidocaine only showed significant efficacy compared with the control at 6 h. There were insufficient trials to draw conclusions regarding atropine, butylscopolamine, chlorpheniramine, clonidine, darifenacin, diphenhydramine, glycopyrrolate, intravesical bupivacaine, ketamine-haloperidol, pethidine-haloperidol, ketorolac, lidocaine-prilocaine cream, magnesium, hyoscine n-butyl bromide, oxycodone, paracetamol, parecoxib, trospium, resiniferatoxin, or amikacin. However, all but pethidine-haloperidol and chlorpheniramine showed some efficacy at various time points compared with controls.. This review suggests that dexmedetomidine, gabapentin, tolterodine, tramadol, ketamine, nefopam, oxybutynin, pregabalin, and PNB are effective in preventing postoperative CRBD. Considering the efficacy and adverse effects of all drugs, dexmedetomidine and gabapentin were ranked best.

Topics: Chlorpheniramine; Dexmedetomidine; Gabapentin; Haloperidol; Humans; Ketamine; Lidocaine; Meperidine; Nefopam; Pain, Postoperative; Pregabalin; Tolterodine Tartrate; Tramadol; Urinary Bladder; Urinary Catheters

To systematically review the literature and provide a comprehensive understanding of the preemptive effects of oral pregabalin on perioperative pain management in lower limb orthopedic surgery.. We searched three electronic databases for randomized controlled trials comparing the results of preoperative pregabalin and placebo in patients undergoing lower limb orthopedic surgery. Data analyses were conducted using RevMan 5.4.. Twenty-one randomized controlled trials met our inclusion criteria. The cumulative opioid consumption within 24 and 48 h postoperatively in the pregabalin group was significantly less than that in the placebo group. The pooled static pain intensity at all time points within the first day was significantly lower in the pregabalin group than in the placebo group. Lower dynamic pain intensity at 48 h was detected in the pregabalin group than in the placebo group. Meanwhile, pregabalin led to a lower incidence of nausea but appeared to be associated with a higher incidence of dizziness and sedation. Subgroup analyses showed that no difference was detected between subgroups stratified by dosing regimen or pregabalin dose in the results of opioid consumption, pain intensity and incidence of complications.. This meta-analysis supports the use of pregabalin preoperatively in patients undergoing lower limb orthopedic surgery. However, it was wary of the resulting increase in dizziness and sedation. There is no evidence to support the continued use of pregabalin postoperatively or using more than 150 mg of pregabalin per day.. This study was registered on 09 November 2021 with INPLASY (registration number: INPLASY2021110031).

Topics: Analgesics; Analgesics, Opioid; Dizziness; Humans; Lower Extremity; Orthopedic Procedures; Pain Management; Pain, Postoperative; Pregabalin

This meta-analysis investigated the effect of oral gabapentinoids (i.e., pregabalin and gabapentin) on analgesic consumption (i.e., primary outcome) and pain relief (i.e., secondary outcome) in patients following bariatric surgery. Analysis of five eligible trials published between 2010 and 2019 including 363 participants receiving gabapentinoids revealed a significantly lower morphine consumption [mean difference (MD) =  - 15.1 mg, p = 0.004; evidence certainty: low] and risk of nausea/vomiting [risk ratio (RR) = 0.49, p = 0.002; evidence certainty: high] at postoperative 6-24 h. There was also a lower pain score at postoperative 0-4 h (MD =  - 1.41, p < 0.00001; evidence certainty: low) and 6-12 h (MD =  - 0.9, p = 0.007; evidence certainty: low) compared with controls, while pain severity at postoperative 24 h was comparable between two groups. In summary, preoperative oral gabapentinoids optimized postoperative pain outcomes and reduced risk of nausea/vomiting following bariatric surgery.

Topics: Analgesics; Bariatric Surgery; Gabapentin; Humans; Laparoscopy; Nausea; Obesity, Morbid; Pain, Postoperative; Pregabalin; Vomiting

With the current opiate epidemic in the United States, there is renewed interest in evaluating non-opiate adjuvant medications as effective alternatives for the prevention and treatment of postoperative pain. A systematic review of randomized, controlled trials on Pub Med, Medline, and Embase was conducted looking on postoperative pain management from 2008 to 2018. Studies were included if they used a gabapentenoid with or without acetaminophen and evaluated supplemental opiate use. All adult (18 years or older) surgical populations were considered for inclusion, and fourteen clinical trials met inclusion criteria. Gabapentenoid dosing varied among studies. In nine of fourteen studies, there was a finding of superiority as compared to placebo in managing postoperative pain and decreasing supplemental opiate use. Pregabalin was used in twelve of the fourteen studies and gabapentin was used in two of the fourteen studies. Of the nine studies that found a benefit from using a gabapentoid, all included pregabalin. While the rate of adverse effects was low in all studies, it was found to increase as dosages increased. Results support that pregabalin has a role in decreasing postoperative pain intensity and supplemental opiate use; however, the optimal dose or dosing regimen is not yet well understood.

Topics: Acetaminophen; Adult; Analgesics; Analgesics, Opioid; Cyclohexanecarboxylic Acids; gamma-Aminobutyric Acid; Humans; Opiate Alkaloids; Pain, Postoperative; Pregabalin

To estimate the acute analgesic efficacy of combined Pregabalin and Celecoxib after operation via a systematic review and meta-analysis.. Studies for inclusion were randomized controlled trials, reporting on relevant outcomes (0-6 hours, 24 hours, 7 days pain scores) with treatment with combined Pregabalin and Celecoxib.. The pooled results from meta-analysis demonstrated that compared with placebo, combined Pregabalin and Celecoxib reduced pain scores at 0 to 6 hours in 3 articles, 24 hours in 5 articles, 7 days in 2 articles (standard mean difference [SMD], -3.10 at 0-6 hours, -2.80 at 24 hours, -1.32 at 7 days, respectively). Combined Pregabalin and Celecoxib could significantly reduce the postoperative narcotic consumption in 3 studies (SMD, -1.99 at 36 hour).. This work suggested that combined Pregabalin and Celecoxib were efficacious in reduction of postoperative pain and narcotic requirements after surgery, whereas more trials are needed to further identify the efficacy of combined Pregabalin and Celecoxib in the management of acute postoperative pain.

Topics: Analgesics; Celecoxib; Humans; Narcotics; Pain, Postoperative; Pregabalin

Adhesions are the most common cause of chronic abdominal pain after surgery. Surgical adhesiolysis can relieve symptoms in selected patients, but many require other treatments. The aim of this study is to evaluate analgesic treatments other than abdominal surgery in chronic pain related to adhesions.. A search was conducted in PubMed, Embase, and Central. Studies with patients suffering from chronic postoperative pain related to adhesions and undergoing all types' analgesic treatment were included. The primary outcome was the number of patients who improved in pain at long-term follow-up (at least 1 year). Secondary outcomes included improvement in pain at 3 months follow-up, quality of life, and physical functioning.. Searches identified 3022 citations. Four studies were included, one trial, one cohort study, and two case reports. The primary outcome was not reported. In a small trial (. Low level of evidence is available regarding analgesic treatments of chronic abdominal and pelvic pain related to adhesions. The benefit of pregabalin is doubtful; nerve modulation is promising in a selected group.HighlightsAdhesions are a frequent cause of chronic abdominal and pelvic pain after surgery.Many patients are not good candidates for surgery (Adhesiolysis) or have relapses of pain.There is an important knowledge gap regarding non-surgical analgesic treatment.Analgesia in adhesion-related chronic abdominal pain after surgery.

Topics: Abdominal Pain; Analgesia; Analgesics; Chronic Pain; Cohort Studies; Humans; Neoplasm Recurrence, Local; Pain, Postoperative; Pelvic Pain; Pregabalin; Quality of Life; Tissue Adhesions

The efficacy of pregabalin for pain management of shoulder arthroscopy remains controversial. We conduct this meta-analysis to explore the influence of pregabalin versus placebo on the postoperative pain intensity of shoulder arthroscopy.. We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through November 2019 for randomized controlled trials assessing the effect of pregabalin versus placebo on pain control of shoulder arthroscopy. This meta-analysis was performed using the random-effect model.. Three randomized controlled trials were included in the meta-analysis. Overall, compared with control group for shoulder arthroscopy, pregabalin remarkably decreased pain scores at 0 to 1 hour (Std. MD = -0.57; 95% CI = -1.04 to -0.09; P = .02) and 12 hours (Std. MD = -0.37; 95% CI = -0.72 to -0.02; P = .04), as well as analgesic consumption (Std. MD = -1.84; 95% CI = -2.24 to -1.44; P < .00001), but showed no notable influence on pain scores at 24 hours (Std. MD = -0.54; 95% CI = -1.47 to 0.38; P = .25), nausea or vomiting (RR = 0.84; 95% CI = 0.53-1.33; P = .45), dizziness (RR = 1.14; 95% CI = 0.89-1.47; P = .30).. Pregabalin may benefit to pain control after shoulder arthroscopy.

Topics: Analgesics; Arthroscopy; Humans; Pain Measurement; Pain, Postoperative; Pregabalin; Randomized Controlled Trials as Topic; Shoulder Joint

Pregabalin has received wide clinical attention as a new type of analgesic. We undertake a systematic review and meta-analysis to evaluate the effect of pregabalin on postoperative pain in patients undergoing cardiac surgery.. We searched PubMed, Embase, and Cochrane Library (from inception to July 2020) for eligible studies. The primary outcomes were the total morphine consumption at 24 h. A secondary outcome was intraoperative fentanyl consumption, extubation time postoperative, and length of stay in hospital. We calculated pooled weighted mean difference (WMD) or odds ratio (OR) and 95% CIs using random- or fixed-effects models.. Seven trials involving 463 patients were listed. Meta-analysis showed that the total morphine consumption at 24 h in the pregabalin group was significantly less than the control group (WMD: -5.44, 95% CI: -10.42-0.46,. Oral pregabalin for cardiac surgery patients can effectively reduce the patient's 24-hour morphine consumption after surgery, shorten the patient's hospital stay, and is more conducive to early postoperative recovery.

Topics: Cardiac Surgical Procedures; Humans; Length of Stay; Pain, Postoperative; Pregabalin; Randomized Controlled Trials as Topic

Pain after tonsil surgery is troublesome because it causes discomfort. In addition, handling patients with postoperative pain is challenging to otolaryngologists. Many laboratory studies have assessed the use of analgesics and surgical techniques to discover methods for effective control of postoperative pain associated with tonsil surgery. In this review article, we summarize and provide a comprehensive overview of current methods for the control of pain after tonsil surgery based on findings of recent studies. Although powered intracapsular tonsillotomy is not popular yet, it seems to be an effective option among various surgical techniques. More discussion about powered intracapsular tonsillotomy should be done in the future. On the other hand, surgery with a harmonic scalpel, fibrin glue, or cryoanalgesia seems ineffective. When reviewing medical treatment methods, the use of nonsteroidal anti-inflammatory drugs, steroids, and/or gabapentin/pregabalin seems to be effective. However, the use of opioid (especially codeine) for children should be avoided because of possible respiratory insufficiency. Ketorolac is dangerous because of the risk of hemorrhage. We should continue to focus on the development of novel postoperative pain control techniques with no or low complications.

Topics: Adrenal Cortex Hormones; Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Cryotherapy; Electrocoagulation; Gabapentin; Humans; Hydrocodone; Laser Therapy; Pain, Postoperative; Pregabalin; Radiofrequency Ablation; Tonsillectomy; Tramadol; Ultrasonic Surgical Procedures

To perform an evidence-based systematic review evaluating perioperative analgesia, including opioid alternatives, used for patients undergoing thyroidectomy and parathyroidectomy.. A comprehensive literature search from 1997 to January 2018 of Pubmed, Cochrane, and EmBase libraries was performed for studies reporting analgesic administration following thyroid or parathyroid surgery. This systematic review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies were evaluated for level of evidence and given a Jadad score to assess for risk of bias. Outcomes gathered included postoperative pain scores, time to rescue analgesia, rescue analgesic consumption, and adverse events.. Thirty-eight randomized controlled trials met inclusion criteria. The GRADE criteria determined the overall evidence to be moderate-high. Studies utilizing NSAIDs reported reduced requirements for rescue analgesics. Acetaminophen studies presented with conflicting data on effectiveness. Gabapentinoid studies demonstrated lower pain scores and an increased time to rescue analgesic. Local anesthetics were effective at decreasing Visual Analogue Scale (VAS) and Numeric Rating Scale (NRS) pain scores while also reducing rescue analgesic consumption. Ketamine was shown to increased postoperative nausea and vomiting. NSAIDs and local anesthetic studies had an aggregate grade of evidence A, while all others had grade B evidence.. There is significant evidence supporting the use of NSAIDs and local anesthetics in the perioperative period for pain management for thyroid and parathyroid surgeries. Acetaminophen, gabapentinoid and ketamine have some supporting evidence and may serve as adequate alternatives. Further multi-institutional RCTs are warranted to delineate optimal analgesic regimens.. NA.

Topics: Acetaminophen; Analgesics; Anesthetics, Local; Anti-Inflammatory Agents, Non-Steroidal; Evidence-Based Medicine; Gabapentin; Humans; Ketamine; Pain Management; Pain, Postoperative; Parathyroidectomy; Perioperative Care; Postoperative Nausea and Vomiting; Pregabalin; Thyroidectomy

The objective of this systematic review was to determine the effectiveness of preoperative oral pregabalin for anxiety control, the most effective dosage regimen, its impact on postoperative pain, and its adverse effects.. A search was conducted of PubMed/Medline and clinicaltrials.gov (National Library of Medicine, Washington, DC), Scopus, Web of Science, and Cochrane databases for studies published between January 2009 and November 2018, with no language restriction. Based on PRISMA guidelines, the specific question was: is preoperative oral pregabalin effective and safe for anxiety control in patients undergoing surgery? The critical reading of retrieved studies followed questions prepared by the CASPe Network, and their methodological quality was evaluated using the Jadad Scale.. Twelve randomized controlled trials were selected for review. All twelve studies were trials of high quality. A dose of 75 mg preoperative oral pregabalin has been found to reduce anxiety and stabilize intraoperative hemodynamics, although a more significant improvement appears to be achieved with a single dose of 150 mg pregabalin at least 1 h before the surgery. It is not associated with any severe adverse effects.. Preoperative administration of oral pregabalin in a single dose of 150 mg appears to be effective to significantly reduce the anxiety of patients, intraoperative hemodynamic changes, and postoperative pain.. These findings suggest that pregabalin is useful and safe for preoperative and intraoperative anxiety control in patients undergoing surgery.

Topics: Analgesics; Anxiety; Humans; Pain, Postoperative; Pregabalin

Gabapentinoids are commonly used as an adjunct to traditional pain management strategies after total joint arthroplasty (TJA). The purpose of this study is to evaluate the efficacy and safety of gabapentinoids in primary TJA to support the combined clinical practice guidelines of the American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, Hip Society, Knee Society, and the American Society of Regional Anesthesia and Pain Management.. The MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were searched for studies published prior to November 2018 on gabapentinoids in TJA. All included studies underwent qualitative and quantitative homogeneity testing followed by a systematic review and direct comparison meta-analysis to assess the efficacy and safety of gabapentinoids.. In total, 384 publications were critically appraised to provide 13 high-quality studies regarded as the best available evidence for analysis. In the perioperative period prior to discharge, pregabalin reduces postoperative opioid consumption, but gabapentinoids do not reduce postoperative pain. After discharge, gabapentin does not reduce postoperative pain or opioid consumption, but pregabalin reduces both postoperative pain and opioid consumption.. Moderate evidence supports the use of pregabalin in TJA to reduce postoperative pain and opioid consumption. Gabapentinoids should be used with caution, however, as they may lead to an increased risk of sedation and respiratory depression especially when combined with other central nervous system depressants such as opioids.

Topics: Analgesics; Analgesics, Opioid; Arthroplasty; Gabapentin; Humans; Pain, Postoperative; Pregabalin

Pregabalin is a drug for neuropathic pain. Antipronociceptive properties of pregabalin have led to its recent use as an adjuvant to the multimodal postoperative pain regimen. This meta-analysis was conducted to evaluate the efficacy of perioperative pregabalin on acute and chronic postsurgical pain (CPSP) after breast cancer surgery.. A meta-analysis including 8 randomized controlled trials searched from MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials was conducted. Subgroup analysis was performed according to doses and timecourse of pregabalin administration. Review Manager 5.3 was selected to conduct the meta-analysis.. Preoperative pregabalin in breast cancer surgery alleviated acute postoperative pain at rest 24 hours after surgery by 0.31 points on an 0 to 10 Numerical Rating Scale (95% confidence interval [CI] -0.57 to -0.05). Morphine consumption showed a decrease in postoperative use by 1.09 mg (95% CI: -1.61 to -0.57). The incidence of CPSP 3 months after surgery was reduced to 46% (95% CI: 0.25-0.85). Postoperative nausea and vomiting, dizziness, and sedation showed no overall significant reductions. However, a decrease in the incidence of postoperative nausea and vomiting and an increase in the incidence of dizziness were noted when patients received 300 mg of pregabalin before surgery.. This study demonstrated that pregabalin showed more efficacy on chronic pain than acute pain after a breast cancer surgery. Further study based on doses and treatment course of pregabalin should be conducted to establish stronger evidence of treatment effects.

Topics: Analgesia; Analgesics; Breast Neoplasms; Female; Humans; Pain, Postoperative; Pregabalin; Randomized Controlled Trials as Topic

Hysterectomy is associated with severe postoperative pain. The relative efficacy of pregabalin compared with other treatments for post-hysterectomy pain is unclear.. We searched the PubMed, Cochrane Library, and Web of Science databases for studies that compared the use of pregabalin and placebo for reducing pain in patients undergoing hysterectomy.. This meta-analysis showed that pregabalin had limited pain-relieving effects at 2, 6, 24, and 48 hours after hysterectomy compared with placebo. Pregabalin significantly reduced postoperative nausea and vomiting. However, there was no significant difference in postoperative sedation or visual disturbances between patients treated with pregabalin and placebo.. Pregabalin is not clinically superior to placebo in terms of reducing pain intensity and morphine consumption in patients undergoing hysterectomy. However, the limitations of this meta-analysis mean that more high-quality randomized controlled trials are necessary to verify our pooled results.

Topics: Acute Pain; Analgesics; Female; Humans; Hysterectomy; Pain, Postoperative; Postoperative Nausea and Vomiting; Pregabalin

The barriers to opioid use in some countries necessitate the need to identify suitable alternatives or adjuncts for pain relief. The gabapentinoids (gabapentin and pregabalin) are approved for the management of persistent pain in adults, but not in children. Searches were conducted in Embase, Medline, Scopus, and Web of Science up until November 2017, for randomized controlled trials that investigated the analgesic effects of gabapentin or pregabalin in children and adolescents <18 years of age. A total of 7 publications were identified, 5 regarding gabapentin as prophylactic postsurgical pain relief for either adenotonsillectomy (n = 3) or scoliosis surgery (n = 2), and 1 for gabapentin treatment of chronic regional pain syndrome/neuropathic pain. One study investigated the efficacy of pregabalin as a treatment for fibromyalgia. Based on the studies' primary outcomes alone, neither of the chronic pain studies involving gabapentin and pregabalin showed significant efficacy compared with amitriptyline or placebo, respectively. Two of the prophylactic gabapentin studies for adenotonsillectomy and idiopathic scoliosis surgery reported significantly fewer children requiring analgesia and lower opioid requirement, respectively, compared with placebo. Two of the identified clinical trials (conducted by the same first author) on the efficacy of gabapentin for prophylactic postadenotonsillectomy pain relief were omitted from narrative synthesis due to clear evidence of fabricated data. Overall, this review identified a paucity of evidence for the analgesic effect and safety of gabapentinoids in children. We also suggest audit of any current evidence-based practice and clinical guidelines that have cited the research studies with fabricated data.

Topics: Adolescent; Analgesics; Child; Evidence-Based Medicine; Gabapentin; Humans; Pain Management; Pain Measurement; Pain, Postoperative; Patient Safety; Practice Guidelines as Topic; Pregabalin; Randomized Controlled Trials as Topic; Treatment Outcome

The purpose of this review is to summarize recent findings on conditioned pain modulation (CPM) in humans with a focus on methodology, factors modulating CPM, and the potential for CPM as a clinical marker for pain progression.. CPM can be evoked by combining different stimulus modalities with good reliability; sequential CPM effects are stable over time with limited carryover effects. Optimism and pain catastrophizing might influence pain inhibition. Further, studies suggest that the CPM effect can be improved by gabapentinoids, transcranial direct current stimulation to cortical structures, and exercise and that long-term opioid use might impair CPM in patients with chronic pain. Clinical evidence suggests that preoperative impaired CPM may predict more severe chronic postoperative pain. The effect of pain duration on CPM impairment has been challenged by recent studies.. As CPM methodology is optimized, studies are revealing factors that can modulate descending pain inhibitory pathways. Understanding underlying mechanisms of CPM will improve the utility of CPM in a clinical setting and potentially lead to personalized treatments for chronic pain patients.

Topics: Analgesics, Opioid; Back Pain; Catastrophization; Chronic Pain; Disease Progression; Exercise; Humans; Neuronal Plasticity; Nociception; Optimism; Pain, Postoperative; Pregabalin; Severity of Illness Index; Transcranial Direct Current Stimulation

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether pregabalin could effectively and safely reduce postoperative pain in patients undergoing pulmonary resections. Altogether 23 papers were found using the reported search, of which 6 randomized controlled trials represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Five of 6 randomized controlled trials demonstrated that the application of oral pregabalin during the perioperative period could effectively reduce postoperative pain after pulmonary resections without compromising patients' safety. One randomized controlled trial reported no difference in the postoperative pain levels between the pregabalin group and the control group. The rates of adverse effects were generally found to be decreased in patients who received pregabalin compared to the patients who received routine analgesia, although 2 studies reported significantly higher incidences of mild drowsiness and dizziness among the pregabalin-treated patients. Currently available evidence supports that the perioperative administration of pregabalin can effectively and safely relieve postoperative pain for patients undergoing pulmonary resections.

Topics: Analgesics; Global Health; Humans; Incidence; Pain Measurement; Pain, Postoperative; Pneumonectomy; Pregabalin

Topics: Analgesics; Humans; Nasal Septum; Pain, Postoperative; Pregabalin; Rhinoplasty

The objectives of this systematic review were to unify criteria on the effectiveness of oral pregabalin to treat acute post-operative pain after cervicofacial surgery, to establish the most effective dose regimens, and to determine its effect on rescue medicine consumption and its association with adverse effects.. PubMed/Medline (National Library of Medicine, Washington, DC), Scopus, Web of Science, and Cochrane databases were searched for studies in any language published between January 2000 and September 2016. The following question was posed, in accordance with PRISMA guidelines: Is oral pregabalin effective and safe for the relief of acute pain after cervicofacial surgery? The critical reading of the literature utilized a list of questions prepared by the CASPe Network, applying the Jadad scale for evaluation of the methodological quality of trials.. Eleven randomized controlled clinical trials were selected. The 11 trials obtained a score ≥ 3, considered as Ib evidence level and high quality. A single oral dose of 75-mg pregabalin before or after cervicofacial surgery alleviates pain and lessens the need for rescue analgesia consumption, while the statistical significance of these effects is higher with a single dose of 150-mg pregabalin, either before or after the surgery.. Oral pregabalin appears to significantly alleviate post-operative pain and reduce rescue analgesia consumption, with no severe adverse effects. However, the ideal dose and most effective administration regimen remain controversial issues that need to be addressed in further high-quality clinical trials.. These findings suggest that pregabalin may be useful for acute pain relief after cervicofacial surgery.

Topics: Acute Pain; Administration, Oral; Analgesics; Facial Pain; Humans; Pain Management; Pain Measurement; Pain, Postoperative; Pregabalin

Gabapentinoids are frequently used in the management of cancer pain. In recent Cochrane systematic reviews, although there was an abundance of evidence relating to non-cancer pain, only a few studies related to cancer pain. This review summarizes recent randomised controlled trials (RCTs) evaluating the use of gabapentinoids for tumour-related (as monotherapy or part of combination therapy) and treatment-related pain.. For tumour-related pain, ten out of thirteen studies showed statistically significant benefits in favour of gabapentinoids. When used, as part of monotherapy or combination therapy, benefits were observed in five out of six studies evaluating gabapentin, and in six out of eight studies evaluating pregabalin. For treatment-related pain, none of the four studies (two gabapentin, two pregabalin) showed statistically significant benefits in favour of gabapentinoids. Unfortunately, many of the studies included were limited by small sample size, lack of blinding, and inadequate follow-up.. More and better quality studies are required, although it may be challenging to accomplish in this patient population. Gabapentinoids may offer benefits to cancer patients with pain, but careful titration and monitoring of adverse effects is necessary.

Topics: Analgesics; Analgesics, Opioid; Cancer Pain; Drug Therapy, Combination; Gabapentin; Humans; Pain; Pain, Postoperative; Palliative Care; Pregabalin; Radiotherapy; Randomized Controlled Trials as Topic; Severity of Illness Index

The focus of perioperative pain management should be to attempt to minimise the nociceptive input and reduce the risk of transition to central sensitisation. Gabapentinoids are being increasingly used as adjuncts for management of perioperative pain. Although gabapentinoids are classed as calcium channel blockers, their mechanisms of action are poorly understood. The analgesic effect in neuropathic pain is well evidenced but the role in postoperative pain is less certain. Medline and EMBASE database searches were conducted to identify studies relating to mechanisms of action and effects in experimental animal models of inflammatory and postoperative pain and human models of experimental pain. The effects of gabapentinoids may be attributed to depression of dorsal horn sensitivity through a multitude of mechanisms. They inhibit calcium mediated neurotransmitter release through effects on α2δ-1 subunits. They inhibit forward trafficking of α2δ-1 from the dorsal root ganglion, their recycling from endosomal compartments, thrombospondin mediated processes and stimulate glutamate uptake by excitatory amino acid transporters. Mechanisms not directly related to neurotransmitter release at dorsal horn include inhibition of descending serotonergic facilitation, stimulation of descending inhibition, anti-inflammatory actions, and influence on the affective component of pain. Gabapentinoids are effective analgesics in most animal models of inflammation and postoperative pain but effects in human models are variable.

Topics: Analgesics; Animals; Calcium Channels; Disease Models, Animal; Gabapentin; gamma-Aminobutyric Acid; Humans; Neuralgia; Pain, Postoperative; Pregabalin

A systematic review of randomized controlled trials (RCTs) was conducted to evaluate the efficacy of pregabalin for the management of postoperative pain in patients undergoing primary total knee arthroplasty (TKA) and primary total hip arthroplasty (THA).. The PubMed, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar databases were searched for related articles using search strategy. RevMan 5.3 software was selected to conduct the meta-analysis.. Seven RCTs were included in our meta-analysis. There were significant differences in visual analogue scale (VAS) at 24 and 48 h with rest, knee flexion degree, mean morphine consumption, and postoperative side effects (nausea, vomiting, pruritus, and dizziness) when comparing the pregabalin group to the placebo group after TKA and THA. However, the differences in VAS at 72 h with rest and at 24 h on movement were not significant between the two groups.. Pregabalin was found to improve pain control at 24 and 48 h with rest, reduce morphine consumption, improve the knee flexion degree, decrease the incident rate of nausea, vomiting, and pruritus, and increase the incident rate of dizziness after TKA and THA but could not improve the pain control at 72 h with rest. In summary, the use of pregabalin may be a valuable asset in pain management within the first 48 h after TKA and THA. However, future studies regarding doses and pregabalin medication are required.

Topics: Analgesics, Non-Narcotic; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Drug Administration Schedule; Humans; Morphine; Narcotics; Pain Management; Pain Measurement; Pain, Postoperative; Postoperative Care; Pregabalin; Randomized Controlled Trials as Topic

Pregabalin has been used as an adjunct for the management of acute pain in laparoscopic cholecystectomy. This meta-analysis aimed to illustrate the efficacy and safety of pregabalin for pain management following laparoscopic cholecystectomy.. In March 2017, a systematic computer-based search was conducted in PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, and Google databases. Data on patients prepared for laparoscopic cholecystectomy in studies that compared pregabalin versus placebo were retrieved. The primary endpoints were the visual analog scale (VAS) score with rest or mobilization at 6, 12, and 24 hours and total morphine consumption. The secondary outcomes were the morphine-related complications (i.e., nausea, vomiting, dizziness, somnolence, headache, pruritus, urine retention, respiratory depression, and blurred vision). Continuous outcomes were expressed as the weighted mean difference (WMD) with a corresponding 95% confidence interval (CI), and discontinuous outcomes were expressed as a risk ratio (RR) with a corresponding 95% CI.. Twelve clinical studies with 938 patients (gabapentin group = 536, control group = 402) were ultimately included in the meta-analysis. Pregabalin was associated with reduced pain scores with rest at 6, 12, and 24 hours, which corresponded to a reduction of 11.27 points at 6 hours, 9.46 points at 12 hours, and 3.99 points at 24 hours on a 100-point VAS. Moreover, pregabalin was associated with reduced pain scores with mobilization at 6, 12, and 24 hours, which corresponded to a reduction of 8.74 points, 5.80 points and 6.37 points at 6, 12, and 24 hours, respectively, on a 110-point VAS. Furthermore, pregabalin reduced the occurrence of nausea and vomiting. There were no significant differences in the occurrence of respiratory depression, pruritus, dizziness, blurred vision, and headache.. Pregabalin was efficacious in the reduction of postoperative pain, total morphine consumption, and morphine-related complications following laparoscopic cholecystectomy. In addition, a high dose of pregabalin was more effective than a low dose. The dose of pregabalin differed across the studies, and the heterogeneity was large. More studies are needed to verify the optimal dose of pregabalin in laparoscopic cholecystectomy patients.

Topics: Acute Pain; Analgesics; Cholecystectomy, Laparoscopic; Humans; Morphine; Pain, Postoperative; Pregabalin; Randomized Controlled Trials as Topic

Amid the current opioid epidemic in the United States, the enhanced recovery after surgery pathway (ERAS) has emerged as one of the best strategies to improve the value and quality of surgical care and has been increasingly adopted for a broad range of complex surgical procedures. The goal of this article was to outline important components of opioid-sparing analgesic regimens.. Regional analgesia, acetaminophen, nonsteroidal anti-inflammatory agents, gabapentinoids, tramadol, lidocaine, and/or the N-methyl-d-aspartate class of glutamate receptor antagonists have been shown to be effective adjuncts to narcotic analgesia. Nonsteroidal anti-inflammatory agents are not associated with an increase in postoperative bleeding. A meta-analysis of 27 randomized clinical trials found no difference in postoperative bleeding between the groups taking ketorolac tromethamine (33 of 1304 patients [2.5%]) and the control groups (21 of 1010 [2.1%]) (odds ratio [OR], 1.1; 95% CI, 0.61-2.06; P = .72). After adoption of the multimodal analgesia approach for a colorectal ERAS pathway, most patients used less opioids while in the hospital and many did not need opioids after hospital discharge, although approximately 50% of patients received some opioid during their stay.. Multimodal analgesia is readily available and the evidence is strong to support its efficacy. Surgeons should use this effective approach for patients both using and not using the ERAS pathway to reduce opioid consumption.

Topics: Acetaminophen; Amines; Analgesics, Non-Narcotic; Analgesics, Opioid; Anesthesia, Conduction; Anti-Inflammatory Agents, Non-Steroidal; Cyclohexanecarboxylic Acids; Gabapentin; gamma-Aminobutyric Acid; Humans; Lidocaine; N-Methylaspartate; Pain, Postoperative; Postoperative Care; Pregabalin; Tramadol

Pre-emptive pregabalin might be beneficial to the patients undergoing laparoscopic cholecystectomy. However, the results remained controversial. We conducted a systematic review and meta-analysis to explore the effect of pregabalin on pain management of patients undergoing laparoscopic cholecystectomy.. PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of pregabalin versus placebo on laparoscopic cholecystectomy were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcome was pain scores Meta-analysis was performed using random-effect model.. Six RCTs involving 434 patients were included in the meta-analysis. Overall, compared with control intervention, pregabalin intervention was found to significantly reduce the pain scores (Std. mean difference = -0.57; 95% CI = -0.85 to -0.29; P < 0.0001) and postoperative fentanyl consumption (Std. mean difference = -1.74; 95% CI = -2.31 to -1.16; P < 0.00001), improve Ramsay Sedation score (Std. mean difference = 1.03; 95% CI = 0.46 to 1.60; P = 0.0004), but demonstrated no influence on nausea and vomiting (RR = 0.82; 95% CI = 0.57 to 1.19; P = 0.30), as well as headache (RR = 0.95; 95% CI = 0.55 to 1.64; P = 0.86).. Compared to control intervention, pregabalin intervention was found to significantly reduce the pain scores and postoperative fentanyl consumption, and improve Ramsay Sedation score in patients undergoing laparoscopic cholecystectomy, but had no influence on nausea and vomiting, as well as headache.

Topics: Analgesics; Cholecystectomy, Laparoscopic; Humans; Pain, Postoperative; Pregabalin

Breast cancer surgery is associated with acute and chronic pain. We sought to systematically evaluate the effects of gabapentin and pregabalin on postoperative pain among patients undergoing breast cancer surgery.. We searched MEDLINE, EMBASE, CENTRAL, Web of Science, and ProQuest from the inception of each database to November 2015. We included studies enrolling adult patients undergoing breast cancer surgery who were randomly assigned to preoperative gabapentin or pregabalin versus placebo or active control and assessed acute (≤24 h) or chronic (≥2 months) pain. We conducted meta-analyses when possible and rated the quality of evidence (QoE) by using the GRADE approach.. Twelve studies were eligible for review, of which eight evaluated gabapentin (n = 516) and four pregabalin (n = 209). Gabapentin reduced pain scores in the recovery room (mean difference [MD] -1.68 on a 0-10 Numeric Rating Scale (NRS), 95% CI -2.59 to -0.77; minimally important difference is 1 point; relative risk [RR] for mild pain (<4/10) 1.71, 95% CI 1.33-2.02; moderate QoE) and 24 h postoperatively (MD -0.52, 95% CI -1.02 to -0.01; RR for mild pain 1.07, 95% CI 1.00-1.13; very low QoE). Pregabalin reduced pain and morphine consumption in the recovery room (MD -6.71 mg, 95% CI -10.73 to -2.70; low QoE). No significant difference was observed in pain score at 24 h (MD -0.38, 95%, CI -0.96 to 0.21; moderate QoE). Neither drug reduced the rate of chronic postoperative pain.. Gabapentin and pregabalin seem to reduce opioid consumption in the recovery room. Gabapentin, but not pregabalin, reduces pain at 24 h after breast cancer surgery. Neither drug affects the development of chronic postoperative pain.. Gabapentin and pregabalin administered perioperatively in patients undergoing breast cancer surgery improve acute postoperative pain as indicated by the reduction in opioid consumption. Further data are needed on reducing chronic postoperative pain.

Topics: Amines; Analgesics; Breast Neoplasms; Chronic Pain; Cyclohexanecarboxylic Acids; Female; Gabapentin; gamma-Aminobutyric Acid; Humans; Mastectomy; Pain, Postoperative; Perioperative Care; Pregabalin; Randomized Controlled Trials as Topic

Whether the preoperative administration of pregabalin plays a beneficial role in controlling acute pain after hysterectomy is unknown. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to determine the efficacy and safety of the preoperative use of pregabalin to treat acute postoperative pain following hysterectomy.. In April 2017, a systematic computer-based search was conducted in the PubMed, EMBASE, Web of Science, Cochrane Library, and Google databases. RCTs comparing pregabalin with placebo in patients undergoing hysterectomy were retrieved. The primary endpoint was the visual analog scale (VAS) score with rest or mobilization at 2 h, 4 and 24 hours and cumulative morphine consumption at 2, 4, 24, and 48 hours. The secondary outcomes were complications of nausea, vomiting, sedation, and dizziness. After tests for publication bias and heterogeneity among studies were performed, the data were aggregated for random-effects models when necessary.. Ten clinical studies with 1207 patients (pregabalin = 760, control = 447) were finally included in this meta-analysis. Preoperative administration of pregabalin was associated with a significant reduction of VAS with rest or mobilization at 2, 4, and 24 hours after hysterectomy. Further, the preoperative administration of pregabalin was associated with a reduction in total morphine consumption at 2, 4, 24, and 48 hours after hysterectomy. The occurrence of morphine-related complications (nausea and vomiting) was also reduced in the pregabalin group. However, the preoperative administration of pregabalin was associated with an increase in the occurrence of dizziness. There was no significant difference in the occurrence of sedation.. The preoperative use of pregabalin reduced postoperative pain, total morphine consumption, and morphine-related complications following hysterectomy. The doses of pregabalin were different, and large heterogeneity was the limitation of the current meta-analysis. Further studies should determine the optimal dose for controlling acute pain after hysterectomy.

Topics: Analgesics; Female; Humans; Hysterectomy; Pain, Postoperative; Postoperative Nausea and Vomiting; Pregabalin; Preoperative Care; Randomized Controlled Trials as Topic

Gabapentinoid drugs, which include gabapentin and pregabalin, play an established role in the management of neuropathic pain. However, whether preoperative administration of gabapentinoids has a beneficial role in controlling acute pain after spinal surgery is unknown. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to determine the efficacy and safety of the preoperative use of gabapentinoids (gabapentin and pregabalin) for the treatment of acute postoperative pain following spinal surgery.. In March 2017, a systematic computer-based search was conducted in PubMed, EMBASE, Web of Science, Cochrane Library, and Google databases. RCTs comparing gabapentinoids (gabapentin and pregabalin) with placebo in patients undergoing spine surgery were retrieved. The primary endpoint was the visual analogue scale (VAS) score with rest or mobilization at 6, 12, 24, and 48 hours and cumulative morphine consumption at 24 and 48 hours. The secondary outcomes were complications of nausea, vomiting, sedation, dizziness, headache, urine retention, pruritus, and visual disturbances. After tests for publication bias and heterogeneity among studies were performed, data were aggregated for random-effects models when necessary.. Sixteen clinical studies (gabapentin group n = 8 and pregabalin group n = 8) were ultimately included in the meta-analysis. Gabapentinoids were associated with reduced pain scores at 6, 12, 24, and 48 hours. Similarly, gabapentinoids were associated with a reduction in cumulative morphine consumption at 24 and 48 hours. Furthermore, gabapentinoids can significantly reduce the occurrence of nausea, vomiting, and pruritus. There were no significant differences in the occurrence of sedation, dizziness, headache, visual disturbances, somnolence, or urine retention.. Preoperative use of gabapentinoids was able to reduce postoperative pain, total morphine consumption, and morphine-related complications following spine surgery. Further studies should determine the optimal dose and whether pregabalin is superior to gabapentin in controlling acute pain after spine surgery.

Topics: Acute Pain; Amines; Analgesics; Cyclohexanecarboxylic Acids; Gabapentin; gamma-Aminobutyric Acid; Humans; Pain, Postoperative; Pregabalin; Randomized Controlled Trials as Topic; Spine

Pregabalin has demonstrated anti-hyperalgesic properties and was introduced into acute pain treatment in 2001. Our aim was to evaluate the beneficial and harmful effects of pregabalin in postoperative pain management. We included randomized clinical trials investigating perioperative pregabalin treatment in adult surgical patients. The review followed Cochrane methodology, including Grading of Recommendations Assessment, Development, and Evaluation (GRADE), and used trial sequential analyses (TSAs). The primary outcomes were 24 h morphine i.v. consumption and the incidence of serious adverse events (SAEs) defined by International Conference of Harmonisation Good Clinical Practice guidelines. Conclusions were based primarily on trials with low risk of bias. Ninety-seven randomized clinical trials with 7201 patients were included. The 24 h morphine i.v. consumption was reported in 11 trials with overall low risk of bias, finding a reduction of 5.8 mg (3.2, 8.5; TSA adjusted confidence interval: 3.2, 8.5). Incidence of SAEs was reported in 21 trials, with 55 SAEs reported in 12 of these trials, and 22 SAEs reported in 10 trials with overall low risk of bias. In trials with overall low risk of bias, Peto's odds ratio was 2.9 (1.2, 6.8; TSA adjusted confidence interval: 0.1, 97.1). Based on trials with low risk of bias, pregabalin may have a minimal opioid-sparing effect, but the risk of SAEs seems increased. However, the GRADE-rated evaluations showed only moderate to very low quality of evidence. Consequently, a routine use of pregabalin for postoperative pain treatment cannot be recommended.

Topics: Acute Disease; Analgesics; Humans; Pain, Postoperative; Pregabalin; Treatment Outcome

Pregabalin is a structural analog of γ-aminobutyric acid that may have a role in acute pain management. It has been used in the perioperative context, but there is controversy regarding its real clinical utility.. To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach.. We identified 21 systematic reviews including 77 randomized trials. We concluded the use of perioperative pregabalin in major surgeries probably does not produce a clinically important decrease in acute postoperative pain. Although it could decrease nausea, postoperative vomiting and opioid requirements, it also produces an increase in sedation.. La pregabalina es un análogo estructural del ácido γ-aminobutírico (GABA), por lo que se cree que pudiese tener un rol en el manejo del dolor agudo. Ha sido utilizada en el contexto perioperatorio, pero existe controversia en relación a su real utilidad clínica.. Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos tablas de resumen de los resultados utilizando el método GRADE.. Identificamos 21 revisiones sistemáticas que en conjunto incluyen 77 ensayos aleatorizados. Concluimos que el uso de pregabalina perioperatoria en cirugías mayores probablemente no produce una disminución clínicamente importante del dolor postoperatorio agudo. Si bien podría disminuir las náuseas y vómitos postoperatorios y el requerimiento de opioides, produce también un aumento en la sedación.

Topics: Acute Pain; Analgesics; Databases, Factual; Humans; Pain, Postoperative; Pregabalin; Randomized Controlled Trials as Topic; Treatment Outcome

Optimal postoperative pain control allows for faster recovery, reduced complications, and improved patient satisfaction. Historically, pain management after spine surgery relied heavily on opioid medications. Multimodal regimens were developed to reduce opioid consumption and associated adverse effects. Multimodal approaches used in orthopaedic surgery of the lower extremity, especially joint arthroplasty, have been well described and studies have shown reduced opioid consumption, improved pain and function, and decreased length of stay. A growing body of evidence supports multimodal analgesia in spine surgery. Methods include the use of preemptive analgesia, NSAIDs, the neuromodulatory agents gabapentin and pregabalin, acetaminophen, and extended-action local anesthesia. The development of a standard approach to multimodal analgesia in spine surgery requires extensive assessment of the literature. Because a substantial number of spine surgeries are performed annually, a standardized approach to multimodal analgesia may provide considerable benefits, particularly in the context of the increased emphasis on accountability within the healthcare system.

Topics: Acetaminophen; Amines; Analgesia; Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Cyclohexanecarboxylic Acids; Drug Administration Routes; Drug Therapy, Combination; Gabapentin; gamma-Aminobutyric Acid; Humans; Pain Management; Pain, Postoperative; Pregabalin; Spine

The efficacy of perioperative pregabalin treatment for preventing chronic pain remains a matter of debate. We searched the MEDLINE, EMBASE, LILACS, Cochrane, and Clinical Trial Register databases, and other sources, for randomized controlled trials comparing the effects of pregabalin and placebo. The primary outcome was the incidence of chronic postsurgical pain (CPSP) at 3 months. The secondary endpoints were CPSP at 3, 6, and 12 months and the incidence of chronic postsurgical neuropathic pain at the same time points. A random-effect meta-analysis was performed on the combined data. Evidence quality was rated by the GRADE method. We included 18 studies (2485 patients) in the meta-analysis. Overall, 60% of the trials reporting the primary outcome at 3 months were unpublished; the unpublished trials corresponded to 1492/1884 (79%) of the patients included in these studies. No difference in CPSP incidence between pregabalin and placebo was found at any time point; the risk ratio was 0.87 (0.66, 1.14), I = 57% at 3 months. The evidence was considered to be of moderate quality. Subgroup analysis by publication status, daily dose, type of administration, and type of surgery did not highlight any differences between subgroups. Insufficient data concerning the incidence of chronic postsurgical neuropathic pain were available for any firm recommendation to be made. Pooled data from published and unpublished studies provide no support for the efficacy of pregabalin for preventing CPSP.

Topics: Analgesics; Drug Administration Schedule; Humans; Pain, Postoperative; Perioperative Period; Pregabalin

We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of pregabalin for pain management following spine surgery.. In September 2016, a systematic computer-based search was conducted in PubMed, EMBASE, Web of Science, and Cochrane Database of Systematic Reviews. RCTs of patients prepared for spine surgery that compared pregabalin with placebo were retrieved. The primary endpoint was the VAS score with rest or mobilization at 12 hours, 24 hours, and 48 hours and cumulative morphine consumption at 24 hours and 48 hours. The secondary outcomes were complications of nausea, sedation, dizziness, headache, and visual disturbances. After testing for publication bias and heterogeneity between studies, data were aggregated for random-effects models when necessary.. Ten clinical studies with 535 patients (pregabalin group = 294, control group = 241) were included in the meta-analysis. Pregabalin was associated with reduced pain scores at 12 hours, 24 hours, and 48 hours, corresponding to a reduction of 1.91 points (95% CI, -4.07 to 0.24 point) at 12 hours, 2.66 points (95% CI, -4.51 to -0.81 point) at 24 hours, and 4.33 points (95% confidence interval, -6.38 to -2.99 point) at 48 hours on a 100-point numeric rating scale. There was no significant difference between VAS scores with mobilization at 12 hours, 24 hours, or 48 hours. Similarly, pregabalin was associated with a reduction in cumulative morphine consumption at 24 hours (-7.07, 95% CI -9.84, -4.30) and 48 hours (-6.52, 95% CI -7.78, -5.25, P = 0.000). Furthermore, pregabalin can reduce the occurrence of nausea (RR 0.57, 95% CI 0.41, 0.79, P = 0.001, number needed to treat = 8.4). There were no significant differences in the occurrence of sedation, dizziness, headache, or visual disturbances.. Preoperative use of pregabalin was efficacious in reduction of postoperative pain, total morphine consumption, and the occurrence of nausea following spine surgery. Because the sample size and the number of included studies were limited, a multicenter RCT is needed to identify the effects and optimal dose of pregabalin for reducing acute pain after spine surgery.

Topics: Analgesics; Early Ambulation; Humans; Lumbar Vertebrae; Morphine; Pain, Postoperative; Pregabalin; Randomized Controlled Trials as Topic

Gabapentin and pregabalin are useful for treating neuropathic pain because of their antiallodynic and antihyperalgesic properties, which may be beneficial in managing acute postoperative pain. The goal of this meta-analysis was to perform a systematic review of the literature on the effect of gabapentinoids on postoperative pain following tonsillectomy, and its adverse effects in patients.. MEDLINE, SCOPUS, and Cochrane database.. Two authors independently searched the databases from their inception of article collection to May 2015. Included in the analysis were studies that compared preoperative gabapentinoid administration (gabapentinoids groups) with a placebo or pain control agent (control group) during a 24-hour postoperative period, the outcomes of interest being postoperative pain intensity; rescue analgesic consumption; or adverse effects such as sedation, nausea and vomiting, dizziness, and headache.. The pain score reported by the physician during the first 8 hours, as well as the need for analgesics during 24 hours postoperatively, were significantly decreased in the gabapentinoids group versus the control group. Additionally, there was no significant difference between gabapentinoids and control groups for adverse effect during 24 hours postoperatively. In the subgroup analyses (gabapentin and pregabalin) regarding pain-related measurements, two subgroups showed the similar effect on reducing the postoperative pain severity.. Preoperative administration of gabapentinoids could provide pain relief without side effects in patients undergoing tonsillectomy. However, considering the insufficient evaluation of efficacy of gabapentinoids according to the high heterogeneity in some parameters, further clinical trials with robust research methodology should be conducted in order to confirm the results of this study.. NA.

Topics: Amines; Analgesics; Cyclohexanecarboxylic Acids; Gabapentin; gamma-Aminobutyric Acid; Humans; Pain Measurement; Pain, Postoperative; Pregabalin; Tonsillectomy

Chronic postoperative pain is common. Nerve injury and inflammation promote chronic pain, the risk of which is influenced by patient factors, including psychological characteristics. Interventional trials to prevent chronic postoperative pain have been underpowered with inadequate patient follow-up. Ketamine may reduce chronic postoperative pain, although the optimum treatment duration and dose for different operations have yet to be identified. The evidence for gabapentin and pregabalin is encouraging but weak; further work is needed before these drugs can be recommended for the prevention of chronic pain. Regional techniques reduce the rates of chronic pain after thoracotomy and breast cancer surgery. Nerve-sparing surgical techniques may be of benefit, although nerve injury is not necessary or sufficient for chronic pain to develop.

Topics: Amines; Analgesics; Chronic Pain; Cyclohexanecarboxylic Acids; Gabapentin; gamma-Aminobutyric Acid; Humans; Ketamine; Pain, Postoperative; Pregabalin; Thoracotomy

Gabapentin and pregabalin has been shown to reduce postoperative pain effectively. In this meta-analysis, we aimed to assess the role of preoperative gabapentinoids for attenuating postoperative pain after nasal surgery in patients via a meta-analysis of the literature.. PubMed, Scopus, and Cochrane Database.. Literature was screened from inception to December 2015. Nine articles to compare the preoperative administered gabapentinoid (gabapentinoids groups) with a placebo or analgesics (control group) were included for analysis of the outcomes of interest, which included postoperative pain scores, analgesic intakes, or side effects, such as sedation, nausea and vomiting, blurred vision, operative bleeding, dizziness, and headache, during a 24-hour postoperative period.. The pain score reported by the physician and need for analgesics during the first 24 hours, postoperatively, in the gabapentinoids group significantly reduced compared with the control. Additionally, the gabapentinoids had no significant effect on the incidences of side effects except blurred vision compared with the control during the 24 hours postoperatively. In the subgroup analyses of these results according to operation type, these subgroups showed similar effects on reducing postoperative pain and adverse effects.. Preoperative gabapentinoids could attenuate postoperative pain without significant adverse effects in patients who undergo nasal surgery. However, blurred vision may be a handicap that requires consideration for use and education for patients. Further clinical trials will be of help in supporting the results of this study.. NA Laryngoscope, 126:2232-2241, 2016.

Topics: Adolescent; Adult; Amines; Analgesics; Cyclohexanecarboxylic Acids; Female; Gabapentin; gamma-Aminobutyric Acid; Humans; Male; Nasal Surgical Procedures; Pain Measurement; Pain, Postoperative; Postoperative Complications; Postoperative Period; Pregabalin; Preoperative Care; Treatment Outcome; Vision Disorders; Young Adult

All chronic pain begins at some discrete point in time. Significant strides in the understanding of mechanisms and risk factors associated with the transition from a new, or acute, pain experience to a chronic pain condition have been made over the past 20 years. These insights provide the hope of one day being able to modify or even halt this pathophysiologic progression. This article reviews some of the current knowledge of this transition as well as the evidence currently available to best prevent and treat it using persistent surgical pain as a model.

Topics: Acute Pain; Amines; Anesthesia, Conduction; Chronic Pain; Cyclohexanecarboxylic Acids; Epigenesis, Genetic; Gabapentin; gamma-Aminobutyric Acid; Humans; Ketamine; Pain, Postoperative; Pregabalin

Total knee arthroplasty is a painful procedure, with approximately half of patients reporting severe pain during the early postoperative period. Gabapentinoids are used as an adjunct for the management of acute pain in approximately half of enhanced recovery programs. We performed a meta-analysis to assess the effectiveness and safety of gabapentinoids for the treatment of acute postoperative pain following total knee arthroplasty.. Randomized controlled trials of patients undergoing elective primary total knee arthroplasty that compared the use of the gabapentinoid class of drugs (gabapentin [Neurontin; Pfizer]) or pregabalin [Lyrica; Pfizer]) with that of placebo were retrieved, with 12 studies meeting inclusion criteria. The primary outcome was pain intensity with activity at 48 hours following the surgical procedure. The secondary outcomes included pain intensity at other time points, opioid consumption, knee function, incidence of chronic pain, and adverse events.. No difference in pain score at 12, 24, 48, or 72 hours following the surgical procedure was seen between gabapentin and placebo. Although pregabalin was associated with reduced pain scores at 24 and 48 hours, this corresponded to a reduction of 0.5 point (95% confidence interval, 0 to 1.0 point) at 24 hours and 0.3 point (95% confidence interval, 0 to 0.6 point) at 48 hours on an 11-point numeric rating scale, which was assessed as not clinically important. Overall, no clinically relevant reduction in pain scores was associated with the use of gabapentinoids. Likewise, gabapentinoids were associated with a small, but not clinically important, reduction in cumulative opioid consumption at 48 hours (mean difference, -23.2 mg [95% confidence interval, -40.9 to -5.4 mg]). There was no difference in knee flexion at 48 hours (p = 0.63) or in the incidence of chronic pain at 3 months (p = 0.31) or 6 months (p = 0.54) associated with the use of gabapentinoids. Although gabapentinoids were associated with a significant reduction in the incidence of nausea (risk ratio, 0.7 [95% confidence interval, 0.6 to 0.9]; p < 0.001), pregabalin was also associated with a significant, clinically relevant increase in the risk of sedation (risk ratio, 1.4 [95% confidence interval, 1.1 to 1.9]; p = 0.02).. On the basis of this meta-analysis, we found no evidence to support the routine use of gabapentinoids in the management of acute pain following total knee arthroplasty.. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Topics: Amines; Analgesics; Arthroplasty, Replacement, Knee; Cyclohexanecarboxylic Acids; Gabapentin; gamma-Aminobutyric Acid; Humans; Pain Measurement; Pain, Postoperative; Pregabalin; Treatment Outcome

The purpose of this systematic review and meta-analysis of randomised controlled trials (RCTs) was to evaluate the effect of pain control of pregabalin versus placebo after a total knee arthroplasty (TKA).. The electronic databases: Medline, Embase, PubMed, CENTRAL (Cochrane Controlled Trials Register), Web of Science and Google were searched from inception to February 2016. This systematic review and meta-analysis were performed according to the PRISMA statement criteria. The primary endpoint was the visual analogue scale (VAS) after a TKA with rest or mobilization at 24 h and 48 h, which represents the effect of pain control after TKA. The cumulative morphine consumption is also assessed to the morphine-sparing effect. The complications of nausea, vomiting, dizziness and sedation were also compiled to assess the safety of pregabalin. Software Stata 12.0 was used for the meta-analysis. After testing for publication bias and heterogeneity across studies, data were aggregated for random-effects modelling when necessary.. Six clinical trials with 769 patients were used for the meta-analysis. The meta-analysis indicated that pregabalin can decrease the VAS with rest at 24 h (MD = -8.14; 95% CI -12.57 to -3.71; P < 0.001) and 48 h (MD = -7.34; 95% CI -11.65 to -3.02; P < 0.001). Pregabalin can decrease the VAS with mobilization at 24 h (MD = -6.56; 95% CI -10.45 to -2.66; P = 0.001) and 48 h (MD = -9.62; 95% CI -12.80 to -6.44; P < 0.001). The results indicated that perioperative pregabalin can decrease the cumulative morphine consumption at 24 h (SMD = -0.97; 95% CI -1.17 to -0.78; P < 0.001) and 48 h (MD = -2.23; 95% CI -2.48 to -1.97; P < 0.001). Moreover, pregabalin can decrease the occurrence of nausea and vomiting but increase the occurrence of dizziness and sedation.. Based on the current meta-analysis, pregabalin has an analgesic and opioid-sparing effect in acute postoperative pain management without increasing the rate of nausea, vomiting.

Topics: Analgesics; Analgesics, Opioid; Arthroplasty, Replacement, Knee; Humans; Morphine; Nausea; Pain Measurement; Pain, Postoperative; Pregabalin

The purpose of this systematic review and meta-analysis of randomised controlled trials (RCTs) was to evaluate the pain control by gabapentin or pregabalin administration versus placebo after total hip arthroplasty (THA).. In January 2016, a systematic computer-based search was conducted in the Medline, Embase, PubMed, CENTRAL (Cochrane Controlled Trials Register), Web of Science and Google databases. This systematic review and meta-analysis were performed according to the PRISMA statement criteria. The primary endpoint was the cumulative morphine consumption and visual analogue scale (VAS) scores at 24 and 48 h with rest or mobilisation. The complications of vomiting, nausea, dizziness and pruritus were also compiled to assess the safety of gabapentin and pregabalin. Stata 12.0 software was used for the meta-analysis. After testing for publication bias and heterogeneity across studies, the data were aggregated for random-effects modelling when necessary.. Seven studies involving 769 patients met the inclusion criteria. The meta-analysis revealed that treatment with gabapentin or pregabalin can decrease the cumulative morphine consumption at 24 h (mean difference (MD) = -7.82; 95 % CI -0.95 to -0.52; P < 0.001) and 48 h (MD = -6.90; 95 % CI -0.95 to -0.57; P = 0.118). Gabapentin or pregabalin produced no better outcome than placebo in terms of VAS score with rest at 24 h (SMD = 0.15; 95 % CI -0.17 to -0.48; P = 0.360) and with rest at 48 h (SMD = 0.22; 95 % CI -0.25 to 0.69; P = 0.363). There was no statistically significant difference between the groups with respect to the VAS score at 24 h postoperatively (SMD = 0.46; 95 % CI -0.19 to 1.11; P = 0.164) and at 48 h postoperatively (SMD = 1.15; 95 % CI -0.58 to 2.89; P = 0.193). Gabapentin decreased the occurrence of nausea (relative risk (RR), 0.49; 95 % CI 0.27-0.92, P = 0.025), but there was no significant difference in the incidence of vomiting, dizziness and pruritus.. On the basis of the current meta-analysis, gabapentin or pregabalin can decrease the cumulative morphine consumption and decrease the occurrence of nausea; however, further trials are needed to assess the efficacy of pain control by gabapentin or pregabalin.

Topics: Amines; Analgesics; Arthroplasty, Replacement, Hip; Cyclohexanecarboxylic Acids; Dizziness; Gabapentin; gamma-Aminobutyric Acid; Humans; Incidence; Morphine; Nausea; Pain Management; Pain Measurement; Pain, Postoperative; Pregabalin; Pruritus; Randomized Controlled Trials as Topic; Treatment Outcome; Vomiting

Pregabalin has been used as an adjuvant in some trials to control postoperative pain after gynecologic surgery. However, the potential clinical advantage remains debatable.. We performed a meta-analysis of clinical trials of pregabalin to evaluate its ability to control acute postoperative pain after gynecologic surgery.. We searched PubMed, ScienceDiret, and the Cochrane Library of Randomized Controlled Trials up to January 2014. We performed a systematic review and meta-analysis of prospective controlled studies reporting pregabalin for gynecologic surgery. The primary outcome was pain outcomes and postoperative cumulative opioid consumption. Data were reported as weighted mean differences (WMDs) and 95% CIs. The secondary outcome was adverse effects after surgery.. Six valid randomized trials met the eligibility criteria and were included in the meta-analysis. Pooled data were collected from 452 patients between 2007 and 2012 (These trials were separately conducted in Greece 2012, India 2011-2012, Turkey 2011, Denmark 2009 and Australia 2007). The pregabalin-treated patients consumed fewer opioids during the first 24 hours postoperatively (WMD, -8.50 mg; 95% CI, -11.29 to -5.71 mg; P < 0.00001). Pain intensity at rest and on movement or coughing revealed a statistically significant pain relief effect of pregabalin during 24 hours postoperatively (at rest: WMD, -6.20 mm; 95% CI, -11.83 to -0.58 mm; P = 0.03; on movement or coughing: WMD, -5.32 mm; 95% CI, -9.73 to -0.91 mm; P = 0.02). No differences were found between the pregabalin and control groups for the adverse effects.. Pregabalin has an analgesic and opioid-sparing effect and does not increase the frequency of adverse effects in acute postoperative pain management after gynecologic surgery.

Topics: Acute Pain; Analgesics, Non-Narcotic; Analgesics, Opioid; Drug Administration Schedule; Drug Therapy, Combination; Female; Gynecologic Surgical Procedures; Humans; Pain, Postoperative; Pregabalin; Prospective Studies; Randomized Controlled Trials as Topic

We performed this systematic review to assess the analgesic efficacy of perioperative pregabalin. Subgroup analyses and meta-regression were performed to assess the impact of individual dose and frequency of pregabalin administration on analgesic efficacy. We included 55 studies. When all doses and administration regimens were combined, pregabalin was associated with a significant reduction in pain scores at rest and during movement and opioid consumption at 24 h compared with placebo {mean difference [95% confidence interval (CI)]=-0.38 (-0.57, -0.20), -0.47 (-0.76, -0.18), and -8.27 mg morphine equivalents (-10.08, -6.47), respectively}. Patients receiving pregabalin had less postoperative nausea and vomiting and pruritus compared with placebo [relative risk (RR) (95% CI)=0.62 (0.48, 0.80) and 0.49 (0.34, 0.70), respectively]. Sedation, dizziness, and visual disturbance were more common with pregabalin compared with placebo [RR (95% CI)=1.46 (1.08, 1.98), 1.33 (1.07, 1.64), and 3.52 (2.05, 6.04), respectively]. All doses of pregabalin tested (≤75, 100-150, and 300 mg) resulted in opioid sparing at 24 h after surgery. There were no significant differences in acute pain outcomes with pregabalin 100-300 mg between single preoperative dosing regimens and those including additional doses repeated after surgery. Data were insufficient to reach conclusions regarding persistent pain, but limited data available from two studies suggested that pregabalin might be effective for the reduction of neuropathic pain. In conclusion, this review suggests that pregabalin improves postoperative analgesia compared with placebo at the expense of increased sedation and visual disturbances.

Topics: Acute Pain; Analgesics; Chronic Pain; gamma-Aminobutyric Acid; Humans; Pain, Postoperative; Pregabalin

Evidence supporting postoperative pain management using pregabalin as an adjunct intervention across various surgical pain models is lacking. The objective of this systematic review was to evaluate "model-specific" comparative effectiveness and harms of pregabalin following a previously published systematic review protocol. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched from inception through August 2013. Data were screened and single extraction with independent verification and dual risk of bias assessment was performed. Quality of evidence (QoE) was rated using the GRADE approach. Primary outcomes were pain relief at rest and on movement and reduction in postoperative analgesic consumption. A total of 1423 records were screened, and 43 studies were included. Perioperative pregabalin resulted in: 16% (95% confidence interval [CI], 9%-21%) reduction in analgesic consumption (moderate QoE, 24 trials) and a small reduction in the magnitude of pain in surgeries associated with pronociceptive pain. Per 1000 patients, 10 more will experience blurred vision (95% CI, 5-20 more; moderate QoE, 17 trials) and 41 more sedation (95% CI, 13-77 more, 17 trials). To prevent 1 case of perioperative nausea and vomiting, the number needed to treat is 11 (95% CI: 7-28, 25 trials). Inadequate evidence addressed outcomes of enhanced recovery and serious harms. Pregabalin analgesic effectiveness is largely restricted to surgical procedures associated with pronociceptive mechanisms. The clinical significance of observed pregabalin benefits must be weighed against the uncertainties about serious harms and enhanced recovery to inform the careful selection of surgical patients. Recommendations for future research are proposed.

Topics: Acute Pain; Analgesics; Humans; Pain Management; Pain, Postoperative; Pregabalin; Preoperative Care; Randomized Controlled Trials as Topic

This article provides an overview of current methods used in acute pain management and explains why effective analgesia is crucial in the early postoperative period. It describes the pharmacology of both common and specialist analgesics, as well as explaining the role and uses of regional and neuraxial analgesia, for the non-anaesthetist.

Topics: Acetaminophen; Amines; Analgesics; Analgesics, Non-Narcotic; Analgesics, Opioid; Anesthesia, Conduction; Anesthetics, Local; Anti-Inflammatory Agents, Non-Steroidal; Cyclohexanecarboxylic Acids; Gabapentin; gamma-Aminobutyric Acid; Humans; Pain Management; Pain, Postoperative; Pregabalin

Laparoscopic surgery is widespread, and an increasing number of surgeries are performed laparoscopically. Early pain after laparoscopy can be similar or even more severe than that after open surgery. Thus, proactive pain management should be provided. Pain after laparoscopic surgery is derived from multiple origins; therefore, a single agent is seldom sufficient. Pain is most effectively controlled by a multimodal, preventive analgesia approach, such as combining opioids with non-opioid analgesics and local anaesthetics. Wound and port site local anaesthetic injections decrease abdominal wall pain by 1-1.5 units on a 0-10 pain scale. Inflammatory pain and shoulder pain can be controlled by NSAIDs or corticosteroids. In some patient groups, adjuvant drugs, ketamine and α2-adrenergic agonists can be helpful, but evidence on gabapentinoids is conflicting. In the present review, the types of pain that need to be taken into account while planning pain management protocols and the wide range of analgesic options that have been assessed in laparoscopic surgery are critically assessed. Recommendations to the clinician will be made regarding how to manage acute pain and how to prevent persistent postoperative pain. It is important to identify patients at the highest risk for severe and prolonged post-operative pain, and to have a proactive strategy in place for these individuals.

Topics: Acetaminophen; Adrenal Cortex Hormones; Adrenergic alpha-2 Receptor Agonists; Amines; Analgesics; Analgesics, Opioid; Anesthetics, Local; Anti-Inflammatory Agents, Non-Steroidal; Combined Modality Therapy; Cyclohexanecarboxylic Acids; Gabapentin; gamma-Aminobutyric Acid; Humans; Laparoscopy; Pain Management; Pain, Postoperative; Pregabalin; Receptors, N-Methyl-D-Aspartate

The efficacy of pregabalin in acute postsurgical pain has been demonstrated in numerous studies; however, the analgesic efficacy and adverse effects of using pregabalin in various surgical procedures remain uncertain. We aim to assess the postsurgical analgesic efficacy and adverse events after pregabalin administration under different surgical categories using a systematic review and meta-analysis of randomized controlled trials.A search of the literature was performed between August 2014 to April 2015, using PubMed, Ovid via EMBASE, Google Scholar, and ClinicalTrials.gov with no limitation on publication year or language. Studies considered for inclusion were randomized controlled trials, reporting on relevant outcomes (2-, 24-hour pain scores, or 24 hour morphine-equivalent consumption) with treatment with perioperative pregabalin.Seventy-four studies were included. Pregabalin reduced pain scores at 2 hours in all categories: cardiothoracic (Hedge's g and 95%CI, -0.442 [-0.752 to -0.132], P = 0.005), ENT (Hedge g and 95%CI, -0.684 [-1.051 to -0.316], P < 0.0001), gynecologic (Hedge g, 95%CI, -0.792 [-1.235 to -0.350], P < 0.0001), laparoscopic cholecystectomy (Hedge g, 95%CI, -0.600 [-0.989 to -0.210], P = 0.003), orthopedic (Hedge g, 95%CI, -0.507 [-0.812 to -0.202], P = 0.001), spine (Hedge g, 95%CI, -0.972 [-1.537 to -0.407], P = 0.001), and miscellaneous procedures (Hedge g, 95%CI, -1.976 [-2.654 to -1.297], P < 0.0001). Pregabalin reduced 24-hour morphine consumption in gynecologic (Hedge g, 95%CI, -1.085 [-1.582 to -0.441], P = 0.001), laparoscopic cholecystectomy (Hedge g, 95%CI, -0.886 [-1.652 to -0.120], P = 0.023), orthopedic (Hedge g, 95%CI, -0.720 [-1.118 to -0.323], P < 0.0001), spine (Hedge g, 95%CI, -1.016 [-1.732 to -0.300], P = 0.005), and miscellaneous procedures (Hedge g, 95%CI, -1.329 [-2.286 to -0.372], P = 0.006). Pregabalin resulted in significant sedation in all surgical categories except ENT, laparoscopic cholecystectomy, and gynecologic procedures. Postoperative nausea and vomiting was only significant after pregabalin in miscellaneous procedures.Analgesic effects and incidence of adverse effects of using pregabalin are not equal in different surgical categories.

Topics: Analgesics; Humans; Pain Measurement; Pain, Postoperative; Pregabalin; Surgical Procedures, Operative; Treatment Outcome

The objective of this review was to provide a comprehensive overview and comparison of results from all prospective randomized trials published to date of medications used to treat pain after photorefrative keratectomy (PRK). A PubMed database search revealed 23 prospective and randomized studies. They included the following classes of medications: nonsteroidal antiimflammatory drugs (NSAIDs), anesthetics, opiates, acetaminophen, gabapentin, and pregabalin. The studies found that although the efficacy of drugs tended to be similar, tetracaine 1% and nepafenac 0.1% tended to have the most analgesic effect. Delayed corneal reepithelialization was a common side effect of both topical anesthetics and topical NSAIDs. Tetracaine 1% resulted in the most significant delay in reepithelialization when tested against placebo control compared with other topical medications tested against placebo. Concomitant use of topical NSAIDs and topical anesthetics, especially tetracaine, may have to be avoided to minimize the risk for delayed corneal healing.. Neither author has a financial or proprietary interest in any material or method mentioned.

Topics: Amines; Analgesics; Analgesics, Opioid; Anesthetics, Local; Anti-Inflammatory Agents, Non-Steroidal; Cyclohexanecarboxylic Acids; Eye Pain; Gabapentin; gamma-Aminobutyric Acid; Humans; Pain, Postoperative; Photorefractive Keratectomy; Pregabalin; Prospective Studies; Randomized Controlled Trials as Topic; Treatment Outcome

With over four million deliveries annually in the United States alone and a constant increase in cesarean delivery rate, childbirth is likely to have a huge impact on the occurrence of acute and possibly chronic postpartum pain. Recent awareness that chronic pain may occur after childbirth has prompted clinicians and researchers to investigate this topic. Current evidence points towards a relatively low incidence of chronic pain after cesarean delivery, with rates ranging between 1% and 18%. To provide a potential mechanistic explanation for the relatively low occurrence of chronic pain after cesarean delivery compared with that after other types of surgery, it has been proposed that endogenous secretion of oxytocin may confer specific protection. Clinical interventions to reduce the incidence and severity of chronic post-surgical pain have not been consistently effective. Likely explanations are that the drugs that have been investigated were truly ineffective or that the effect was too modest because with a low incidence of chronic pain, studies were likely to be underpowered and failed to demonstrate an effect. In addition, since not all women require preventive therapies, preoperative testing that may identify women vulnerable to pain may be highly beneficial. Further research is needed to identify valid models that predict persistent pain to allow targeted interventions to women most likely to benefit from more tailored anti-hyperalgesic therapies.

Topics: Acute Pain; Adrenergic alpha-Agonists; Adult; Amines; Analgesics; Anesthetics, Dissociative; Cesarean Section; Chronic Pain; Clonidine; Cyclohexanecarboxylic Acids; Female; Gabapentin; gamma-Aminobutyric Acid; Humans; Injections, Spinal; Ketamine; Magnesium Sulfate; Nerve Block; Oxytocin; Pain, Postoperative; Parturition; Pelvic Pain; Peritoneum; Pregabalin; Pregnancy; Risk Factors; Uterus

Chronic pain can often occur after surgery, substantially impairing patients' health and quality of life. It is caused by complex mechanisms that are not yet well understood. The predictable nature of most surgical procedures has allowed for the conduct of randomized controlled trials of pharmacological interventions aimed at preventing chronic postsurgical pain.. The primary objective was to evaluate the efficacy of systemic drugs for the prevention of chronic pain after surgery by examining the proportion of patients reporting pain three months or more after surgery. The secondary objective was to evaluate the safety of drugs administered for the prevention of chronic pain after surgery.. We identified randomized controlled trials (RCTs) of various systemically administered drugs for the prevention of chronic pain after surgery from CENTRAL, MEDLINE, EMBASE and handsearches of other reviews and trial registries. The most recent search was performed on 17 July 2013.  . Included studies were double-blind, placebo-controlled, randomized trials involving adults and evaluating one or more drugs administered systemically before, during or after surgery, or both, which measured pain three months or more after surgery.. Data collected from each study included the study drug name, dose, route, timing and duration of dosing; surgical procedure; proportion of patients reporting any pain three months or more after surgery, reporting at least 4/10 or moderate to severe pain three months or more after surgery; and proportion of participants dropping out of the study due to treatment-emergent adverse effects.. We identified 40 RCTs of various pharmacological interventions including intravenous ketamine (14 RCTs), oral gabapentin (10 RCTs), oral pregabalin (5 RCTs), non-steroidal anti-inflammatories (3 RCTs), intravenous steroids (3 RCTs), oral N-methyl-D-aspartate (NMDA) blockers (3 RCTs), oral mexiletine (2 RCTs), intravenous fentanyl (1 RCT), intravenous lidocaine (1 RCT), oral venlafaxine (1 RCT) and inhaled nitrous oxide (1 RCT). Meta-analysis suggested a modest but statistically significant reduction in the incidence of chronic pain after surgery following treatment with ketamine but not gabapentin or pregabalin. Results with ketamine should be viewed with caution since most of the included trials were small (that is < 100 participants per treatment arm), which could lead to the overestimation of treatment effect.. Additional evidence from better, well designed, large-scale trials is needed in order to more rigorously evaluate pharmacological interventions for the prevention of chronic pain after surgery. Furthermore, available evidence does not support the efficacy of gabapentin, pregabalin, non-steroidal anti-inflammatories, intravenous steroids, oral NMDA blockers, oral mexiletine, intravenous fentanyl, intravenous lidocaine, oral venlafaxine or inhaled nitrous oxide for the prevention of chronic postoperative pain.

Topics: Adrenal Cortex Hormones; Adult; Amines; Analgesics; Chronic Pain; Cyclohexanecarboxylic Acids; Female; Gabapentin; gamma-Aminobutyric Acid; Humans; Ibuprofen; Ketamine; Male; Mexiletine; Pain, Postoperative; Pregabalin; Randomized Controlled Trials as Topic

Systematic review and meta-analysis.. To review the literature systematically and make a comprehensive understanding of the efficacy of these 2 drugs in the management of postoperative pain after lumbar spinal surgery.. Several trials that evaluated the efficacy of gabapentin and pregabalin in the management of postoperative pain after lumbar spinal surgery have been published.. PubMed (1980 to present), adapted for EMBASE (1980 to present), and Cochrane databases were searched for randomized placebo-controlled trials. Random effect model was used in our meta-analysis, and standard mean difference (SMD) was chosen as the pooled estimate.. Seven trials were included in our study. All included studies could be considered to be of high quality in methodology. The pooled results from meta-analysis demonstrated that compared with placebo, both gabapentin and pregabalin could significantly reduce the postoperative narcotic consumption (SMD, -1.54, and -1.16, respectively). Oral gabapentin was efficacious in the management of postoperative pain at all time points during the first day after surgery (SMD, -1.91 at 0-6 hr, -1.30 at 6-12 hr, -1.05 at 12-24 hr, respectively). Pregabalin seemed to be also efficacious in the management of postoperative pain at 0 to 6 hours (SMD, -1.05), at 6 to 12 hours (SMD, -0.62), and at 12 to 24 hours (SMD, -0.43). Both drugs could be well tolerated in our included trials, compared with placebo.. This work suggested that both gabapentin and pregabalin were efficacious in reduction of postoperative pain and narcotic requirements after lumbar spinal surgery, whereas more trials were needed to further assess the efficacy of pregabalin in the management of postoperative pain after lumbar spinal surgery.. 1.

Topics: Amines; Analgesics; Cyclohexanecarboxylic Acids; Gabapentin; gamma-Aminobutyric Acid; Humans; Lumbar Vertebrae; Pain, Postoperative; Pregabalin; Randomized Controlled Trials as Topic; Treatment Outcome

Topics: Amines; Analgesics; Chronic Pain; Cyclohexanecarboxylic Acids; Gabapentin; gamma-Aminobutyric Acid; Humans; Pain, Postoperative; Perioperative Care; Pregabalin

On the initiative of the Dutch Association of Anaesthesiologists, a multidisciplinary workgroup has revised the 2003 practice guideline on 'Postoperative pain treatment' for adults and children. The main reason for revision was the availability of new drugs and new methods of administration. The most important deviations from the previous edition are the following. The organisation of care has been amended according to the current themes of the Safety Management System in the Netherlands, and a prediction model for postoperative pain was added. The drugs oxycodone, S-ketamine, pregabalin, gabapentin and metamizole were added, as well as new methods of administration and techniques for preventing postoperative pain. This revised guideline is more conservative than the previous one in the choice of epidural analgesia. In patients with relative contraindications for epidural analgesia, peripheral and locoregional blocks or multimodal pain treatment are advised. In the case of postoperative nausea and vomiting, administration of dexamethasone, droperidol and 5-HT3-antagonists is recommended, preferably in combination. Non-medicinal treatment options are not recommended.

Topics: Adult; Amines; Analgesia, Epidural; Child; Cyclohexanecarboxylic Acids; Dexamethasone; Gabapentin; gamma-Aminobutyric Acid; Humans; Ketamine; Netherlands; Pain, Postoperative; Postoperative Nausea and Vomiting; Practice Guidelines as Topic; Pregabalin

Untreated acute postoperative pain can transform into chronic pain that may have major negative effects on the individual's quality of life. It can also prolong recovery, rehabilitation and length of hospital stay, thus affecting societal economic burden. Given the multiplicity of mechanisms involved in postoperative pain, a multimodal analgesia regimen, using a combination of opioids and multiple agents aiming to augment their effects via different routes of administration, is a pharmacologically appropriate approach. This polypharmacological application provides superior pain relief at rest and after movement, reduced opioid consumption associated with reduced analgesic-related adverse effects, and better chances to prevent the induction of later hyperalgesia. The most important adjuncts currently employed are ketamine and gabapentinoids. They have been shown to help in reaching the desired effect when administered at drug-specific modes and at proven effective dosing throughout the perioperative period.

Topics: Adjuvants, Pharmaceutic; Amines; Analgesics; Animals; Cyclohexanecarboxylic Acids; Gabapentin; gamma-Aminobutyric Acid; Humans; Ketamine; Pain, Postoperative; Perioperative Period; Pregabalin

Many clinical trials have demonstrated the effectiveness of gabapentin and pregabalin administration in the perioperative period as an adjunct to reduce acute postoperative pain. However, very few clinical trials have examined the use of gabapentin and pregabalin for the prevention of chronic postsurgical pain (CPSP). We (1) systematically reviewed the published literature pertaining to the prevention of CPSP (≥ 2 months after surgery) after perioperative administration of gabapentin and pregabalin and (2) performed a meta-analysis using studies that report sufficient data. A search of electronic databases (Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, IPA, and CINAHL) for relevant English-language trials to June 2011 was conducted.. The following inclusion criteria for identified clinical trials were used for entry into the present systematic review: randomization; double-blind assessments of pain and analgesic use; report of pain using a reliable and valid measure; report of analgesic consumption; and an absence of design flaws, methodological problems or confounders that render interpretation of the results ambiguous. Trials that did not fit the definition of preventive analgesia and did not assess chronic pain at 2 or more months after surgery were excluded.. The database search yielded 474 citations. Eleven studies met the inclusion criteria. Of the 11 trials, 8 studied gabapentin, 4 of which (i.e., 50%) found that perioperative administration of gabapentin decreased the incidence of chronic pain more than 2 months after surgery. The 3 trials that used pregabalin demonstrated a significant reduction in the incidence of CPSP, and 2 of the 3 trials also found an improvement in postsurgical patient function. Eight studies were included in a meta-analysis, 6 of the gabapentin trials demonstrated a moderate-to-large reduction in the development of CPSP (pooled odds ratio [OR] 0.52; 95% confidence interval [CI], 0.27 to 0.98; P = 0.04), and the 2 pregabalin trials found a very large reduction in the development of CPSP (pooled OR 0.09; 95% CI, 0.02 to 0.79; P = 0.007).. The present review supports the view that perioperative administration of gabapentin and pregabalin are effective in reducing the incidence of CPSP. Better-designed and appropriately powered clinical trials are needed to confirm these early findings.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amines; Analgesics; Chronic Pain; Cyclohexanecarboxylic Acids; Drug Administration Schedule; Evidence-Based Medicine; Female; Gabapentin; gamma-Aminobutyric Acid; Humans; Incidence; Male; Middle Aged; Odds Ratio; Pain Measurement; Pain, Postoperative; Perioperative Period; Pregabalin; Time Factors; Treatment Outcome; Young Adult

Topics: Amines; Analgesics; Cyclohexanecarboxylic Acids; Gabapentin; gamma-Aminobutyric Acid; Hand; Humans; Neuralgia; Pain, Postoperative; Pregabalin

Numerous studies support the theory that pregabalin causes an antihyperalgesic effect, which could be potentially beneficial in a perioperative setting. By binding to calcium channels pregabalin reduces the release of excitatory neurotransmitters and therefore inhibits central sensitization. Animal studies clearly demonstrated the antihyperalgesic potency of pregabalin but human experiments are, however, inconclusive. Clinical studies with quantitative sensory testing have not yet been published. Although strongly supported by theoretical considerations the routine preoperative application of pregabalin for the prevention of hyperalgesia cannot be recommended due to the lack of clinical studies. Future studies should incorporate secondary hyperalgesia and allodynia as primary parameters.

Topics: Analgesics; Animals; Calcium Channels; Disease Models, Animal; gamma-Aminobutyric Acid; Humans; Hyperalgesia; Pain, Postoperative; Pregabalin; Premedication

Multimodal treatment of postoperative pain using adjuncts such as gabapentin is becoming more common. Pregabalin has anti-hyperalgesic properties similar to gabapentin. In this systematic review, we evaluated randomized, controlled trials (RCTs) for the analgesic efficacy and opioid-sparing effect of pregabalin in acute postoperative pain. A systematic search of Medline (1966-2010), the Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar was performed. We identified 11 valid RCTs that used pregabalin for acute postoperative pain. Postoperative pain intensity was not reduced by pregabalin. Cumulative opioid consumption at 24 h was significantly decreased with pregabalin. At pregabalin doses of <300 mg, there was a reduction of 8.8 mg [weighted mean difference (WMD)]. At pregabalin doses ≥300 mg, cumulative opioid consumption was even lower (WMD, -13.4 mg). Pregabalin reduced opioid-related adverse effects such as vomiting [risk ratio (RR) 0.73; 95% confidence interval (CI) 0.56-0.95]. However, the risk of visual disturbance was greater (RR 3.29; 95% CI 1.95-5.57). Perioperative pregabalin administration reduced opioid consumption and opioid-related adverse effects after surgery.

Topics: Acute Disease; Analgesics, Non-Narcotic; Dose-Response Relationship, Drug; gamma-Aminobutyric Acid; Humans; Pain, Postoperative; Pregabalin; Randomized Controlled Trials as Topic; Treatment Outcome

We calculated in a meta-analysis the effect size for the reduction of post-operative pain and post-operative analgesic drugs, which can be obtained by the perioperative administration of pregabalin. Three end-points of efficacy were analysed: early (6 h-7 days) post-operative pain at rest (17 studies) and during movement (seven studies), and the amount of analgesic drugs in the studies that obtained identical results for pain at rest (12 studies). Reported adverse effects were also analysed. The daily dose of pregabalin ranged from 50 to 750 mg/day. The duration of treatment in patients assessed for pain ranged from a single administration to 2 weeks. Pregabalin administration reduced the amount of post-operative analgesic drugs (30.8% of non-overlapping values - odds ratio=0.43). There was no effect with 150, and 300 or 600 mg/day provided identical results. Pregabalin increased the risk of dizziness or light-headedness and of visual disturbances, and decreased the occurrence of post-operative nausea and vomiting (PONV) in patients who did not receive anti-PONV prophylaxis. The administration of pregabalin during a short perioperative period provides additional analgesia in the short term, but at the cost of additional adverse effects. The lowest effective dose was 225-300 mg/day.

Topics: Analgesics; Analgesics, Opioid; Confusion; Dizziness; Dose-Response Relationship, Drug; Endpoint Determination; gamma-Aminobutyric Acid; Humans; Muscle Fatigue; Odds Ratio; Pain Measurement; Pain, Postoperative; Postoperative Nausea and Vomiting; Pregabalin; Randomized Controlled Trials as Topic; Sleep Stages; Vision Disorders

Topics: Acetaminophen; Adrenergic alpha-2 Receptor Agonists; Adrenergic beta-Antagonists; Ambulatory Surgical Procedures; Analgesics; Anesthetics, Local; Anti-Inflammatory Agents, Non-Steroidal; Anticonvulsants; gamma-Aminobutyric Acid; Glucocorticoids; Humans; Injections, Intra-Articular; Pain, Postoperative; Pregabalin; Receptors, N-Methyl-D-Aspartate

More than 75% of patients undergoing surgery suffer from acute pain. Most of this pain transforms into chronic pain. Currently, treatment of postoperative pain is based mainly on opioids, but results are not quite satisfactory. Postoperative pain is defined as a condition of tissue injury together with muscle spasm after surgery. Recently, peripheral and central sensitization has been shown within the mechanisms of postoperative pain generation. Accordingly, anti-convulsive drugs have been used successfully for the treatment of postoperative pain. Therefore, the issue of whether postoperative pain is purely a nociceptive pain remains a topic of debate. Considering that every surgical intervention might result in a nerve injury, it is not surprising to find neuropathic pain features within the postoperative pain itself. In light of these findings, it would be more precise to define postoperative pain as a combination of inflammatory and neuropathic components instead of as pure pain. Thus, the appropriate postoperative treatment should be planned involving both of these components.

Topics: Amines; Analgesics; Cyclohexanecarboxylic Acids; Gabapentin; gamma-Aminobutyric Acid; Humans; Nociceptors; Pain, Postoperative; Pregabalin; Treatment Outcome

Recently, much attention has been directed towards the effect of opioid-sparing strategies on postoperative morbidity and hospitalization, and on different nociceptive mechanisms involved in various postoperative pain states and surgical procedures. This has resulted in an increased interest in secondary, or adjunct, analgesics and procedure-specific analgesic methods.. The present paper aims to review and discuss recent developments within the field of various adjunct, systemic analgesics and local/regional anesthetic methods for management of postoperative pain, based on evidence from randomized, clinical trials published within the last 5 years.. The reader will gain insight into the current role of pregabalin, glucocorticoids and systemic lidocaine for the management of postoperative pain. In addition, the current status of local infiltration analgesia for hip and knee arthroplasty, transversus abdominis plane block for abdominal operations, and the analgesic effect of wound instillation of capsaicin are reviewed.. The evidence of a substantial analgesic effect of pregabalin on acute postoperative pain is questionable, and more convincing evidence of the role of glucocorticoids and systemic lidocaine is needed before they should be recommended as analgesics in daily clinical practice. Local infiltration analgesia after hip and knee arthroplasty, transversus abdominis plane block after abdominal operations and local application of capsaicin lend some promise, but there is still a lack of well-performed RCTs to draw any firm conclusions. Procedure-specific analgesic combinations within well-defined rehabilitation paradigms should be explored further to reduce adverse effects associated with the use of conventional analgesic treatment protocols, and to improve postoperative outcome.

Topics: Analgesia; Analgesics; Analgesics, Opioid; Animals; Capsaicin; Disease Management; gamma-Aminobutyric Acid; Humans; Lidocaine; Pain, Postoperative; Pregabalin; Randomized Controlled Trials as Topic

Topics: Analgesics; Animals; gamma-Aminobutyric Acid; Herpes Zoster; Humans; Mice; Neuralgia; Pain, Postoperative; Pregabalin; Rats

Multimodal postoperative pain management targeted at diminishing harmful outcomes should include pregabalin in cases that need opioid reduction and when the risk of developing chronic neuropathic postsurgical pain is present. Gabapentanoids have grown in importance due to their opioid-sparing effects. They may also contribute to the prevention of chronic postsurgical pain.. We reviewed the literature regarding the use of gabapentanoids and their role in treatment modalities in acute postsurgical pain. Dosing, therapeutic efficacy, side effects, and their role within a multimodal regimen are discussed. Particular emphasis is placed on their ability to provide an opioid-sparing effect, as well as on their potential for inhibiting chronic neuropathic pain. A Pubmed search of pregabalin, gabapentin, acute pain, multimodal analgesia, chronic postsurgical pain, and neuropathic pain between 2000 and 2010 was done. Relevant articles - including randomized controlled trials, retrospective trials, case series, case reports, and review articles - were filtered to include those that relate to postsurgical pain.. Readers will gain an increased appreciation of the role of pregabalin in postsurgical pain in patients at risk of developing chronic pain.. Pregabalin is a safe and effective medication that may decrease perioperative opioid use in patients with more acute neuropathic pain than acute inflammatory pain. When surgery involves more neuropathic-type acute pain there is growing evidence that pregabalin may decrease the incidence of chronic pain.

Topics: Acute Disease; Analgesics; Analgesics, Opioid; Chronic Disease; Dose-Response Relationship, Drug; gamma-Aminobutyric Acid; Humans; Neuralgia; Pain, Postoperative; Pregabalin

Multimodal analgesia incorporates the use of analgesic adjuncts with different mechanisms of action to enhance postoperative pain management. Acetaminophen, anti-inflammatories, and gabapentinoids provide effective analgesia while reducing opioid requirements and opioid-related side effects. Intrathecal morphine and periarticular local anesthetic infiltration further enhance dynamic analgesia and improve postoperative mobilization. Epidural analgesia, peripheral nerve blocks, tramadol, ketamine, and/or clonidine can be added for improved benefit in opioid-tolerant individuals.

Topics: Amines; Analgesia; Analgesics; Anesthetics, Local; Arthroplasty, Replacement, Hip; Combined Modality Therapy; Cyclohexanecarboxylic Acids; Cyclooxygenase 2 Inhibitors; Gabapentin; gamma-Aminobutyric Acid; Humans; Pain, Postoperative; Pregabalin

Poor pain management has been a problem after ambulatory surgery. This review examines the current situation and recent advances in the area.. Despite significant scientific advances in the management of postoperative pain, surveys continue to show poor pain control in the routine clinical setting of day-case surgery. Causes are poor implementation of the progress and lack of adherence to established guidelines with too much reliance on opioids and lack of continuation of analgesic techniques into the postoperative period. The current literature with regard to systemic analgesia supports the concept of multimodal analgesia with an emphasis on the widespread use of appropriate nonopioids including NSAIDs or cyclo-oxygenase-2 inhibitors. The other mainstay of pain management after ambulatory surgery should be local anaesthetics, either used single shot, but with appropriate adjuvants, or by continuous peripheral nerve blocks. The latter techniques show increasingly promising results with a good safety record and are reviewed extensively.. Multimodal analgesia and local anaesthetic techniques are the avenues to improve the still disappointing quality of analgesia after ambulatory surgery.

Topics: Ambulatory Surgical Procedures; Analgesics; Analgesics, Opioid; Anesthetics, Local; gamma-Aminobutyric Acid; Humans; Nerve Block; Pain, Postoperative; Peripheral Nerves; Pregabalin

Gabapentin and pregabalin inhibit Ca(2+) currents via high-voltage-activated channels containing the alpha2delta-1 subunit, reducing neurotransmitter release and attenuating the postsynaptic excitability. They are antiepileptic drugs successfully used also for the chronic pain treatment. A large number of clinical trials indicate that gabapentin and pregabalin could be effective as postoperative analgesics. This systematic-narrative review aims to analyse the most recent evidences regarding the effect of gabapentinoids on postoperative pain treatment.. Medline, The Cochrane Library, EMBASE and CINHAL were searched for recent (2006-2009) randomized clinical trials (RCTs) of gabapentin-pregabalin for postoperative pain relief in adults. Quality of RCTs was evaluated according to Jadad method. Visual analogue scale (VAS), opioid consumption and side-effects (nausea, vomiting, dizziness and sedation) were considered the most important outcomes.. An overall of 22 gabapentin (1640 patients), 8 pregabalin (707 patients) RCTs and seven meta-analysis were involved in this review. Gabapentin provided better post-operative analgesia and rescue analgesics sparing than placebo in 6 of the 10 RCTs that administered only pre-emptive analgesia. Fourteen RCTs suggested that gabapentin did not reduce PONV when compared with placebo, clonidine or lornoxicam. Pregabalin provided better post-operative analgesia and rescue analgesics sparing than placebo in two of the three RCTs that evaluated the effects of pregabalin alone vs placebo. Four studies reported no pregabalin effects on preventing the PONV.. Gabapentin and pregabalin reduce pain and opioid consumption after surgery in confront with placebo, but comparisons with other standard post-operative regimens are not sufficient. Gabapentin and pregabalin seem not to have any influence on the prevention of PONV.

Topics: Adult; Amines; Analgesics; Cyclohexanecarboxylic Acids; Evidence-Based Medicine; Female; Gabapentin; gamma-Aminobutyric Acid; Humans; Male; Middle Aged; Pain, Postoperative; Pregabalin; Randomized Controlled Trials as Topic

Topics: Administration, Cutaneous; Amines; Analgesics; Analgesics, Opioid; Antidepressive Agents; Arthritis; Chemotherapy, Adjuvant; Chronic Disease; Cyclohexanecarboxylic Acids; Diabetic Neuropathies; Diagnosis, Differential; Gabapentin; gamma-Aminobutyric Acid; Humans; Lidocaine; Low Back Pain; Pain; Pain Measurement; Pain, Postoperative; Practice Guidelines as Topic; Pregabalin; Wounds and Injuries

Postoperative incisional pain is a unique and common form of acute pain. Although ample evidence indicates that an efficeous postoperative pain treatment reduces patient morbidity and patient outcome, recent studies demonstrate that about 50-70% of patients experience moderate to severe pain after surgery indicating that postoperative pain remains poorly treated. Perhaps important reasons for this quandary are distinct mechanisms of incisional nociception compared to other pain conditions limiting our regimen to drugs designed for other clinical pain problems. Another reason might be the lack of an in depth knowledge about the pathophysiology and neuropharmacology of postoperative pain. Basic research offers important insights in the mechanisms of postsurgical incisional pain and the translation of experimental results into clinical practice will have important implications on the improvement of new multimodal treatment regimens based postoperative pain mechanisms. In the present review, recent developments in experimental postsurgical incisional pain research will be described and their possible relevance for clinical practice discussed.

Topics: Amines; Analgesia; Cyclohexanecarboxylic Acids; Excitatory Amino Acid Antagonists; Gabapentin; gamma-Aminobutyric Acid; Humans; Hyperalgesia; Pain, Postoperative; Pregabalin; Receptors, N-Methyl-D-Aspartate

Gabapentin and pregabalin have antiallodynic and antihyperalgesic properties useful for treating neuropathic pain. These properties may also be beneficial in acute postoperative pain. In this study we evaluated randomized, controlled trials examining the analgesic efficacy, adverse effects, and clinical value of gabapentinoids in postoperative pain.. A systematic search of Medline, PubMed, and Cochrane Central Register of Controlled Trials (CENTRAL) databases yielded 22 randomized, controlled trials on perioperative administration of gabapentinoids for postoperative pain relief.. Pain relief was better in the gabapentin groups compared with the control groups. The opioid-sparing effect during the first 24 h after a single dose of gabapentin 300-1200 mg, administered 1-2 h preoperatively, ranged from 20% to 62%. The combined effect of a single dose of gabapentin was a reduction of opioid consumption equivalent to 30 +/- 4 mg of morphine (mean +/- 95% CI) during the first 24 h after surgery. Metaregression analysis suggested that the gabapentin-induced reduction in the 24-h opioid consumption was not significantly dependent on the gabapentin dose. Gabapentin reduced opioid-related adverse effects, such as nausea, vomiting, and urinary retention (number-needed-to-treat 25, 6, and 7, respectively). The most common adverse effects of the gabapentinoids were sedation and dizziness (number-needed-to-harm 35 and 12, respectively).. Gabapentinoids effectively reduce postoperative pain, opioid consumption, and opioid-related adverse effects after surgery. Conclusions about the optimal dose and duration of the treatment cannot be made because of the heterogeneity of the trials. Studies are needed to determine the long-term benefits, if any, of perioperative gabapentinoids.

Topics: Amines; Cyclohexanecarboxylic Acids; Dizziness; Gabapentin; gamma-Aminobutyric Acid; Humans; Pain, Postoperative; Perioperative Care; Pregabalin; Randomized Controlled Trials as Topic

Gabapentin and pregabalin bind to the alpha-2-delta calcium channel subunit and represent a novel analgesic drug class. The evidence base supporting their use for chronic neuropathic and early postsurgical pain is reviewed.. Multiple, large, high-quality trials have demonstrated the safety and efficacy of gabapentin and pregabalin in neuropathic pain. Treatment-related improvement of pain and sleep positively impact upon quality of life. Sedation, dizziness and ataxia are important and relatively common adverse effects, however. Accumulating evidence indicates that gabapentin, and possibly pregabalin, also exert important effects following surgery. Multiple high-quality trials have demonstrated analgesic and opioid-sparing efficacy with gabapentin following various surgical procedures. Gabapentin and pregabalin reduce movement-evoked pain and this can lead to enhanced functional postoperative recovery. Postoperative opioid sparing is of questionable relevance since few trials have shown reduced opioid-related adverse effects. Sedation, dizziness and ataxia have been reported in only a few trials. Future larger-scale perioperative trials focused on safety assessment are needed, however.. Gabapentin and pregabalin are efficacious treatments for neuropathic and postsurgical pain. Future research addressing several specific questions would serve to better delineate their optimal roles in treating these and other pain conditions.

Topics: Amines; Analgesics; Cyclohexanecarboxylic Acids; Diabetic Neuropathies; Female; Forecasting; Gabapentin; gamma-Aminobutyric Acid; Humans; Male; Neuralgia; Pain; Pain, Postoperative; Pregabalin

Substantial progress has been made during the last decades in our understanding of acute pain mechanisms, and this knowledge has encouraged the search for novel treatments. Of particular interest has been the observation that tissue injury initiates a number of modulations of both the peripheral and the central pain pathways, which convert the system from a 'physiological' to a 'pathological' mode of processing afferent information. Gabapentin, which binds to the alpha(2)delta subunit of the voltage-dependent calcium channel, is active in animal models of 'pathological' but not in models of 'physiological' pain. Consequently, attention has so far been focused on neuropathic pain as a target for the clinical use of gabapentin and analogues. Recently, several reports have indicated that gabapentin may have a place in the treatment of post-operative pain. This article presents a brief summary of the potential mechanisms of post-operative pain, and a systematic review of the available data of gabapentin and pregabalin for post-operative analgesia. It is concluded that the results with gabapentin and pregabalin in post-operative pain treatment published so far are promising. It is suggested that future studies should explore the effects of 'protective premedication' with combinations of various antihyperanalgesic and analgesic drugs for post-operative analgesia.

Topics: Amines; Analgesics; Animals; Cyclohexanecarboxylic Acids; Gabapentin; gamma-Aminobutyric Acid; Humans; Pain Measurement; Pain, Postoperative; Peripheral Nervous System Diseases; Pregabalin; Randomized Controlled Trials as Topic

Preemptive multimodal analgesia is a commonly used technique to control pain following total knee arthroplasty (TKA). This study aimed to evaluate the efficacy of pre-emptive opioids for pain management in patients who underwent TKA.. In this prospective, double-blind, placebo-controlled, randomized trial, 100 patients who underwent TKA at our hospital were randomized to the oxycodone or control group. At 2 hours before surgery, patients in the oxycodone group received 400 mg celecoxib, 150 mg pregabalin, and 10 mg extended-release oxycodone hydrochloride. Patients in the control group received 400 mg celecoxib, 150 mg pregabalin, and placebo. The primary outcome was postoperative consumption of morphine hydrochloride as rescue analgesia. Secondary outcomes were time to first rescue analgesia, postoperative pain assessed by the visual analogue scale, functional recovery assessed by range of knee motion and ambulation distance, time until hospital discharge, indicators of liver function, and complication rates.. The 2 groups were similar in mean postoperative 0 to 24 hour morphine consumption (11.4 mg for control versus 12.4 mg for oxycodone group, P = .419) and mean total morphine consumption (18.2 versus 19.8 mg, P = .227). There were no statistical differences in secondary outcomes.. In our study, preemptive opioid administration did not provide clinical benefits over placebo. Orthopaedic surgeons should consider not using pre-operative opioids in patients undergoing TKA.

Topics: Analgesics, Opioid; Arthroplasty, Replacement, Knee; Celecoxib; Double-Blind Method; Humans; Morphine; Oxycodone; Pain, Postoperative; Pregabalin; Prospective Studies

Some studies have pointed to gabapentinoids as promising medications in postoperative pain control. The objective of the present study was to evaluate the efficacy of pregabalin in reducing postoperative pain in tonsillectomy and lateral pharyngoplasties.. Double-blind randomized controlled trial.. Tertiary care center.. A double-blind randomized controlled trial was conducted with patients undergoing tonsillectomies and lateral pharyngoplasties between Aug 29, 2017, and Oct 31, 2020. Data of interest such as opioid consumption, pain scores, and adverse outcomes such as dizziness, nausea, headache, and sedation within 7 days following surgeries were analyzed.. No statistically significant difference was observed in pain scores and opioid consumption between the groups studied in the pilot project. The use of pregabalin was associated with lower incidence of dizziness compared to controls.. Gabapentinoids, especially pregabalin, are drugs whose potential for controlling pain after pharyngeal surgery, such as tonsillectomy and sleep apnea surgery, still needs to be more fully evaluated. After the conclusion of the present study, we hope to answer this question about the role of pregabalin in oropharyngeal surgeries.

Topics: Analgesics; Analgesics, Opioid; Dizziness; Humans; Pain, Postoperative; Pilot Projects; Pregabalin; Tonsillectomy

Postoperative pain is one of the main negative symptoms resulting from surgery and the use of new methods to control this symptom is of ever-increasing relevance. Opioid-sparing strategies, such as multimodal analgesia, are trends in this scenario. Pregabalin is a well-established treatment for neuropathic pain; however, it is still controversial in the surgical context for postoperative analgesia. This study investigated the effect of pregabalin on postoperative analgesia in patients undergoing abdominal hysterectomy. It is a prospective, randomised, double-blind, placebo-controlled clinical trial. Female patients undergoing abdominal hysterectomy were randomised to use pregabalin (group P1), 300 mg orally 2 h before surgery, or identical placebo pills (group P0). The main outcome includes the postoperative pain index by visual analogue scale (VAS) and McGill's pain questionnaire. Secondary outcomes include opioid consumption and the presence of adverse effects. A value of p < 0.05 was used to reject type I error. Fifty-five patients were randomised amongst the groups. Patients in group P1 had lower pain rates by VAS scale, both at rest and in active motion, than group P0. In McGill's questionnaire, patients from group P1 also had lower pain rates (12 × 28.5). There was approximately twice as much opioid consumption amongst patients in group P0. Regarding side effects, there was a difference between the two groups only for dizziness, being more incident in group P1. This study suggests that pregabalin is an important adjuvant drug in treating postoperative pain in patients with abdominal hysterectomy.

Topics: Analgesia; Analgesics; Analgesics, Opioid; Double-Blind Method; Female; Humans; Hysterectomy; Pain, Postoperative; Pregabalin; Prospective Studies

The purpose of the present study (a randomized clinical trial) was to evaluate the preemptive analgesic effects of pregabalin combined with celecoxib in total knee arthroplasty (TKA).. From January 2019 to June 2021, we enrolled 149 patients who underwent TKA and divided them into four groups: the placebo group (. The pain scores upon movement were significantly lower in the combination group than in the other three groups at 6, 12, 24, and 48 hours after surgery (. The preemptive analgesia regimen of pregabalin combined with celecoxib had positive effects on improving acute pain and reducing the cumulative dose of opioids after TKA. This trial is registered with ChiCTR2100041595.

Topics: Analgesia; Analgesics, Opioid; Arthroplasty, Replacement, Knee; C-Reactive Protein; Celecoxib; Double-Blind Method; Humans; Pain; Pain, Postoperative; Pregabalin; Prospective Studies; Sufentanil

Gabapentinoids are often administered preoperatively, as they have been shown to reduce postoperative opioid consumption and pain scores however sedation has always been a concern because of sedative side effect.. This study was intended to compare oral gabapentin versus oral pregabalin sedative effects and complications in patients undergoing lumbar spine surgery under general anaesthesia.. This study was a true experimental randomised, placebo-controlled, prospective study, conducted at Rafedia Government Surgical Hospital in Nablus, Palestine. The sample consisted of 60 male and female patients undergoing elective lumbar spine surgeries in the department of neurology and aged from 18 to 70 years. The patients were divided into three groups (20 patients each): The pregabalin 150mg group, the gabapentin group and the placebo group.. Nearly 51.7% of the participants reported that they experienced a feeling of nausea or vomiting after the operation. There were statistically significant differences (p-value = 0.008) between the groups in how often complications happen after surgery.. Preemptive pregabalin (150mg) was established to have a more sedative effect and lowered complications than gabapentin (300mg).

Topics: Analgesics; Anesthesia, General; Female; Gabapentin; Humans; Hypnotics and Sedatives; Male; Pain, Postoperative; Pregabalin; Prospective Studies

The side effects of pregabalin likely occur after the first dose. We aimed to evaluate the effect of 75 milligrams (mg) of pregabalin prescribed as an initial dose with a slow dose escalation for primary total joint arthroplasty within the enhanced recovery after surgery pathway.. Participants were randomly assigned to two groups. Fifty-eight patients were enrolled, and twenty-nine were assigned to each group. Group 1 (G1) received pregabalin (37.5 mg) twice on the day before surgery, as well as pregabalin 75 mg two hours pre-operatively; Group 2 (G2) received none on the day before surgery and the same dose of pregabalin at two hours pre-operatively. The primary outcome was dizziness assessed by severity; secondary outcomes included nausea, vomiting, sedation, opioid consumption, independent transfer at six hours post-operatively, time to readiness for independent transfers, time to readiness for discharge, and pain.. At two, four, and six hours post-operatively, the proportion of patients experiencing dizziness and nausea was significantly greater in G2 than in G1, and opioid consumption was significantly greater in G2 than in G1 (P = .012). The proportion of independent transfers at six hours post-operatively was significantly greater in G1 than in G2 (P = .010). The time to readiness for independent transfers was significantly shorter in G1 than in G2 (P = .016).. Prescription of pregabalin 37.5 mg twice on the day before surgery was effective in reducing early postoperative dizziness and nausea after receiving pregabalin 75 mg two hours pre-operatively. It also promoted early independent transfers and reduced opioid consumption.

Topics: Analgesics; Analgesics, Opioid; Arthroplasty; Dizziness; Enhanced Recovery After Surgery; Humans; Nausea; Pain, Postoperative; Pregabalin

Surgical procedures performed in the suboccipital and subtemporal regions are associated with severe pain. The present study was designed to determine pregabalin's effect on postoperative pain in elective craniotomy.. This double-blind prospective randomized clinical trial was conducted on 50 patients aged 20-60 with ASA classifications I and II. The patients who qualified for elective craniotomies were split into intervention (two capsules =300 mg pregabalin) and control groups (two capsule starch). Patients were also assessed at recovery, 2, 6, 12, and 24 h after surgery for their pain and level of sedation. Data were analyzed by SPSS software version 23, and a P-value ≤ 0.05 was considered significant.. The mean pain score in the intervention group was lower than the control group at recovery (p = 0.224), 2 h (p = 0.001), 6 h (p = 0.011), and 12 h (p = 0.032) after surgery. The methadone consumption in the control group was significantly higher than the intervention group (p < 0.05). There was no significant difference between the two groups regarding the level of sedation (p > 0.05). The mean heart rate at induction (p = 0.01), 15 min (p = 0.01), 30 min (p = 0.025), recovery (p = 0.031), and 2 h (p = 0.021) after surgery and the MAP at recovery, 2 h, and 6 h after surgery was significantly lower than the control group (p = 0.029), (p = 0.013), and (p = 0.038), respectively.. Our investigation demonstrated the effectiveness of pregabalin two hours before surgery on decreasing postoperative pain and analgesic consumption without disturbance in neurological examinations and any specific adverse effects.

Topics: Analgesics; Craniotomy; Double-Blind Method; Humans; Pain, Postoperative; Pregabalin; Prospective Studies

Perioperative pain management is one of the most challenging issues for patients with spinal neoplasms. Inadequate postoperative analgesia usually leads to severe postsurgical pain, which could cause patients to suffer from many other related complications. Meanwhile, there is no appropriate analgesic strategy for patients with spinal neoplasms.. This is a protocol for a randomized double-blind controlled trial to evaluate the effect of esketamine combined with pregabalin on postsurgical pain in spinal surgery. Patients aged 18 to 65 years scheduled for spinal neoplasm resection will be randomly allocated into the combined and control groups in a 1:1 ratio. In the combined group, esketamine will be given during the during the surgery procedure until 48-h postoperative period, and pregabalin will be taken from 2 h before the surgery to 2 weeks postoperatively. The control group will receive normal saline and placebo capsules at the same time points. Both groups received a background analgesic regimen by using patient-controlled intravenous analgesia (containing 100 μg sufentanil and 16 mg ondansetron) until 2 days after surgery. To ensure the accuracy and reliability of this trial, all the researchers and patients will be blinded until the completion of this study. The primary outcome will be the proportion of patients with acute moderate-to-severe postsurgical pain (visual analog scale, VAS ≥ 40, range: 0-100, with 0, no pain; 100, the worst pain) during the 48-h postoperative period. The secondary outcomes will include the maximal VAS scores (when the patients felt the most intense pain over the last 24 h before being interviewed) at 0-2 h, 2-24 h, 24-48 h, and 48-72 h after leaving the operating room and 24 h before discharge; the incidence of acute moderate-to-severe postsurgical pain at each other time point; chronic postsurgical pain assessment; neuropathic pain assessment; and the incidence of drug-related adverse events and other postoperative complications, such as postoperative delirium and postoperative nausea and vomiting (PONV).. The aim of this study was to evaluate the effect of esketamine combined with pregabalin on acute postsurgical pain in patients undergoing resection of spinal neoplasms. The safety of this perioperative pain management strategy will also be examined.. ClinicalTrials.gov NCT05096468. Registered on October 27, 2021.

Topics: Analgesics; Double-Blind Method; Humans; Pain, Postoperative; Pregabalin; Randomized Controlled Trials as Topic; Reproducibility of Results; Spinal Neoplasms

Ureteroscopy is a commonly performed procedure, with postoperative pain that can lead to revisits and opioid prescribing. Perioperative gabapentinoids have shown promise in decreasing pain and opioid use. We hypothesized that single-dose perioperative pregabalin would be safe and efficacious for decreasing pain after ureteroscopy.. This was an Institutional Review Board-approved and registered blinded, placebo-controlled trial conducted at a single institution. Patients undergoing ureteroscopy without histories that would limit use of opioids, gabapentinoids, and nonsteroidal medications were enrolled. Either 300 mg pregabalin or placebo was administered 1 hour before ureteroscopy. Pain was assessed using a visual analogue scale before administration and 1 hour after surgery. Clinical factors, pain scores, a proxy for cognition, patient satisfaction, and opioid prescribing were assessed in the first 30 postoperative days.. A total of 118 patients were enrolled over a 2-year period. Patients who received pregabalin were younger than those who received placebo (median of 44 years vs 57). Postoperative pain scores were higher in those who received pregabalin (3.7 vs 2.0,. In this trial evaluating the efficacy of single-dose perioperative pregabalin in ureteroscopy, pregabalin did not decrease postoperative pain when compared to placebo. Urologists should not routinely use this adjunctive medication in ureteroscopy, as it is unlikely to provide benefit.

Topics: Analgesics; Analgesics, Opioid; Double-Blind Method; Humans; Pain, Postoperative; Practice Patterns, Physicians'; Pregabalin; Ureteroscopy

Perioperative multimodal analgesia can prevent chronic pain after breast cancer surgery. This study aimed to investigate the efficacy of combined perioperative oral pregabalin and postoperative esketamine in preventing chronic pain after breast cancer surgery.. Ninety patients undergoing elective breast cancer surgery were randomized into the combined pregabalin and esketamine group (EP group) and the general anesthesia alone group (Control group). The EP group received 150 mg of oral pregabalin 1 h before surgery and twice daily for seven days postoperatively, and a patient-controlled analgesia pump after surgery that delivered 100 μg sufentanil + 1.25 mg/kg esketamine + 4 mg tropisetron in 100 mL saline solution intravenously. The Control group received placebo capsules before and after the surgery and routine postoperative analgesia (100 μg sufentanil + 4 mg tropisetron in 100 mL saline solution). The primary outcome was the incidence of chronic pain three and six months after surgery. Secondary outcomes included acute postoperative pain, postoperative opioid consumption, and incidence of adverse events.. The incidence of chronic pain in the EP group was significantly lower than in the Control group three (14.3% vs 46.3%,. Combined perioperative oral pregabalin and postoperative esketamine effectively prevented chronic pain after breast cancer surgery, improved acute postoperative pain, and reduced postoperative opioid consumption.

Topics: Analgesics, Opioid; Breast Neoplasms; Chronic Pain; Female; Humans; Pain, Postoperative; Pregabalin; Saline Solution; Sufentanil; Tropisetron

Patients experience considerable postoperative pain after spinal surgery. As the spine is located at the centre of the body and supports body weight, severe postoperative pain hinders upper body elevation and gait which can lead to various complications, including pulmonary deterioration and pressure sores. It is important to effectively control postoperative pain to prevent such complications. Gabapentinoids are widely used as preemptive multimodal analgesia, but their effects and side effects are dose-dependent. This study was designed to examine the efficacy and side effects of varying doses of postoperative pregabalin for the treatment of postoperative pain after spinal surgery.. This is a prospective, randomized controlled, double-blind study. A total of 132 participants will be randomly assigned to the placebo (n = 33) group or to the pregabalin 25 mg (n = 33), 50 mg (n = 33), or 75 mg (n = 33) groups. Each participant will be administered placebo or pregabalin once prior to surgery and every 12 h after surgery for 72 h. The primary outcome will be the visual analogue scale pain score, total dose of administered intravenous patient-controlled analgesia, and frequency of rescue analgesic administered for 72 h from arrival to the general ward after surgery, subdivided into four periods: 1-6 h, 6-24 h, 24-48 h, and 48-72 h. The secondary outcomes will be the incidence and frequency of nausea and vomiting due to intravenous patient-controlled analgesia. Safety will be assessed by monitoring the occurrence of side effects such as sedation, dizziness, headache, visual disturbance, and swelling.. Pregabalin is already widely used as preemptive analgesia and, unlike nonsteroidal anti-inflammatory drugs, is not associated with a risk of nonunion after spinal surgery. A recent meta-analysis demonstrated the analgesic efficacy and opioid-sparing effect of gabapentinoids with significantly decreased risks of nausea, vomiting, and pruritus. This study will provide evidence for the optimal dosage of pregabalin for the treatment of postoperative pain after spinal surgery.. ClinicalTrials.gov NCT05478382. Registered on 26 July 2022.

Topics: Analgesics; Double-Blind Method; Humans; Nausea; Pain, Postoperative; Pregabalin; Prospective Studies; Randomized Controlled Trials as Topic; Vomiting

Preemptive multimodal analgesia is a frequently utilized method for controlling pain after total knee arthroplasty (TKA). So far, no studies have specifically examined the efficacy of adding acetaminophen to preemptive multimodal analgesia in TKA. The current work aimed to assess the efficacy of adding acetaminophen to preemptive multimodal analgesia for clinical pain management after TKA.. This was a double-blinded randomized study including 80 cases randomized to the acetaminophen and control groups, respectively. The acetaminophen group was administered celecoxib at 400 mg, pregabalin at 150 mg, and acetaminophen at 300 mg 2 h before TKA. Control patients were administered celecoxib, pregabalin, and placebo. The primary outcome was postsurgical use of morphine hydrochloride for rescue analgesia. Secondary outcomes included the time to the initial rescue analgesia, postsurgical pain as determined by a visual analogue scale (VAS), functional recovery as reflected by the range of knee motion and ambulation distance, hospitalization duration, and complication rates. Continuous data with normal and skewed distributions were compared by the Student's t test and the Mann-Whitney U test, respectively. Categorical variables were compared by the Pearson's chi-squared test.. The control and acetaminophen groups were comparable in postoperative 0-24 h morphine consumption (11.3 ± 6.5 mg vs 12.3 ± 7.7 mg, P = 0.445) and total morphine consumption (17.3 ± 10.1 mg vs 19.3 ± 9.4 mg, P = 0.242). Additionally, time to the initial rescue analgesia, postoperative VAS score at any time point, postoperative functional recovery of the knee, and hospitalization duration were similar in both groups. Both groups also had similar occurrence rates of postoperative complications.. In this study, adding acetaminophen to preoperative preemptive multimodal analgesia did not decrease postoperative morphine use or ameliorate pain relief. The efficacy of adding acetaminophen to preemptive multimodal analgesia in TKA need to be further explored in future studies.

Topics: Acetaminophen; Analgesia; Analgesics, Opioid; Arthroplasty, Replacement, Knee; Celecoxib; Double-Blind Method; Humans; Morphine; Pain, Postoperative; Pregabalin

The best tool for management of postherpetic neuralgia (PHN) is a matter of debate. The use of ultrasound-guided erector spinae plane block (ESPB) in patients with PHN may decrease pain severity and the need for analgesics.. The objective of this clinical study was to test the efficacy of ESPB with and without the addition of magnesium sulphate on pain control and analgesic consumption in patients with PHN.. Randomized controlled double-blinded trial.. A single university center.. A total of 75 patients with PHN were included in the study. Patients were randomly divided into 3 equal groups. Group A received sham ESPB (2 mL normal saline), Group B received ESPB with 20 mL of bupivacaine (0.25%), and Group C received ESPB with 20 mL of bupivacaine (0.25%) and 100 mg magnesium sulphate. All patients received standard medical care. The pain score, the consumption of pregabalin and acetaminophen, the incidence of complications, and the patient's satisfaction were measured and recorded.. In comparison to the control group, the use of real ESPB with or without the addition of magnesium significantly decreased the Numeric Rating Scale score for pain during the first week of follow-up (P < 0.05); decreased the mean daily consumption of pregabalin and acetaminophen from the third to the twelfth week of follow-up (P < 0.05); and increased the level of patients' satisfaction (P = 0.03). The addition of magnesium sulphate showed an insignificant difference in comparison to the use of bupivacaine alone in ESPB (P ? 0.05).. The study was limited by being a singlecenter study, using a single-level injection, and using a single volume of local anesthetic mixture.. ESPB with or without adding magnesium sulphate is an effective pain management tool for cases of PHN. It leads to a significant decrease in pain score and analgesic requirements.

Topics: Acetaminophen; Analgesics; Bupivacaine; Humans; Magnesium; Magnesium Sulfate; Nerve Block; Neuralgia, Postherpetic; Pain, Postoperative; Pregabalin

Severe acute pain is a significant risk factor for postherpetic neuralgia (PHN). The importance of early management in alleviating zoster pain cannot be overstated.. This study aimed to determine the efficiency and safety of one bolus injection thoracic paravertebral block (PVB) and erector spinae plane block (ESB) in individuals with acute thoracic herpes zoster (HZ) in preventing PHN.. A prospective randomized controlled trial.. Tanta University Hospitals, Tanta, Egypt.. Ninety participants over the age of 50 years with chest wall herpetic eruption, lasting shorter than a week along with moderate to severe pain, who got adequate antiviral medication. Patients were chosen at random and classified into 3 equal groups. Group C (control group) did not receive any intervention. Group ESB received US-guided ESB with 25 mg bupivacaine 0.5%, plus 8 mg dexamethasone (10 mL volume). Group PVB received US-guided PVB with 25 mg bupivacaine 0.5%, plus 8 mg dexamethasone (10 mL volume).. Numerical rating scale (NRS) showed insignificant differences at baseline. NRS for pain at 1, 3, 4, 12, and 24 weeks was significantly reduced in group ESB compared to group C and in group PVB than group C and insignificantly different between group ESB and group PVB. Doses of pregabalin and acetaminophen were comparable at 1 week among the studied groups. Doses of pregabalin and acetaminophen at 3, 4, 12, and 24 weeks were significantly lesser in group ESB compared to group C and in group PVB than group C and insignificantly different between group ESB and group PVB. After 3 months, the incidence of persistent herpetic pain was not significantly different between the study groups. After 6 months, the incidence of persistent herpetic pain was statistically significantly lower in groups ESB and PVB than in group C (P = 0.037 and 0.015, respectively) without significant difference between group ESB and group PVB.. Small sample size, single center study.. Both ESB and PVB were effective in controlling acute pain and persistent herpetic pain after 6 months (which was evident by lower NRS for pain and doses of pregabalin and acetaminophen), but ESB is safer (no reported pneumothorax and hypotension).

Topics: Acetaminophen; Acute Pain; Antiviral Agents; Bupivacaine; Dexamethasone; Herpes Zoster; Humans; Middle Aged; Nerve Block; Neuralgia, Postherpetic; Pain, Postoperative; Pregabalin; Prospective Studies; Ultrasonography, Interventional

Adequate pain control is critical after outpatient surgery where patients are not as closely monitored. A multimodal pain management regimen was compared to a conventional pain management method in patients undergoing operative fixation for distal radius fractures. We hypothesized that there would be a decrease in the amount of narcotics used by the multimodal group compared to the conventional pain management group, and that there would be no difference in bone healing postoperatively.. Forty-two patients were randomized into 2 groups based on pain protocols. Group 1, the control, received a regional block, acetaminophen, and oxycodone. Group 2 received a multimodal pain regimen consisting of daily doses of pregabalin, celecoxib, and acetaminophen up until postoperative day (POD) #3. They also received a regional block with oxycodone for breakthrough pain.. From POD#3 to week 1, there was a significant increase in oxycodone use in the study group correlating with the point in time when the multimodal regimen was discontinued. The shortened Disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) scores taken at 2 weeks postoperation showed a significantly lower average score in the study group compared to the control. There was no difference in bone healing.. The 2 regimens yielded similar pain control after surgery. The rebound increase in narcotic use after the multimodal regimen was discontinued, and significant difference in QuickDASH scores seen at 2 weeks postoperatively supported that multimodal regimens may not necessarily lead to decreased narcotic use in outpatient upper extremity surgery, but in the short term are shown to improve functional status.

Topics: Acetaminophen; Analgesics, Opioid; Celecoxib; Humans; Narcotics; Oxycodone; Pain Management; Pain, Postoperative; Pregabalin; Radius Fractures

To compare the analgesic effects of pregabalin to those of single-shot interscalene brachial plexus block (ISBPB) in adults having arthroscopic rotator cuff (RC) repair, as well as ISBPB's effect on postoperative opioid consumption, patient satisfaction, and opioid-related adverse effects.. In this randomized trial, 79 adults having arthroscopic RC repair were randomized to receive perioperative oral pregabalin (Lyrica, twice daily starting the evening before surgery, for a total of 4 doses) or single-shot ISBPB (20 ml of bupivacaine 0.25%). Intra- and postoperative management was standardized. The primary outcome was median self-reported pain score (on a visual analog scale of 0 to 100) at rest during the initial 10 postoperative days. Other outcomes included pain during activity, postoperative opioid consumption, opioid-related adverse effects, quality of recovery, and pain satisfaction score.. Of 71 eligible patients, 59 were analyzed, of whom 29 received pregabalin and 30 received ISBPB. Groups were similar regarding demographic, baseline, and intraoperative variables. Median pain score at rest over the 10 postoperative days was 51 (interquartile range 26, 76) in the pregabalin group and 52 (22, 74) in the ISBPB group (difference 0.5 points; 95% confidence interval [CI] -3.2 to 6.3; P = .53). Opioid consumption during the initial 10 postoperative days was also similar (difference in median 90 mg of morphine equivalents; 95% CI -32 to 177.5; P = .12). No differences were found in any other outcome.. Perioperative use of pregabalin in adults undergoing arthroscopic RC repair provided analgesia comparable to that of ISBPB for 10 days after surgery.. II, randomized controlled trial (high dropout rate).

Topics: Adult; Anesthetics, Local; Arthroscopy; Brachial Plexus Block; Humans; Pain, Postoperative; Pregabalin; Rotator Cuff; Rotator Cuff Injuries

Serious pain commonly occurs after posterior spinal surgery. This study aims to evaluate the effect of preemptive and multimodal analgesia using celebrex, pregabalin and ropivacaine on pain control after this surgery.. Ninety-three patients undergoing posterior spinal surgery were enrolled in this prospective, randomized, double-blind, placebo-controlled clinical trial. All patients were treated with patient- controlled analgesia (PCA, intravenous tramadol hydrochloride and flurbiprofen) as required. They were randomized to combination analgesia intervention (oral celebrex, pregabalin and subcutaneous infiltration of ropivacaine), ropivacaine intervention (only subcutaneous infiltration of ropivacaine), and control intervention (placebo). We compared postoperative visual analog scale (VAS) scores and PCA dose among the three groups.. The VAS scores were significantly lower in the combination analgesia group than in the control group at 0 h, 2 h, 12 h, 24 h, 3 d, 5 d, 7 d and 14 d after posterior spinal surgery, while combination analgesia was also superior to ropivacaine in terms of VAS scores at 24 h and 14 d postoperatively. The combination analgesia group was also associated with significantly reduced PCA consumption compared with the control group, but there was no statistical difference in PCA consumption between the ropivacaine group and control group.. Combination analgesia using celebrex, pregabalin and ropivacaine is effective and safe to alleviate pain after posterior spinal surgery.. Chinese Clinical Trial Registry No. ChiCTR2000031236.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Analgesics, Opioid; Celecoxib; Dose-Response Relationship, Drug; Double-Blind Method; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Molecular Structure; Pain Measurement; Pain, Postoperative; Pregabalin; Ropivacaine; Spinal Fractures; Spinal Fusion; Structure-Activity Relationship; Young Adult

The aim of this study was to compare the effects of pregabalin, betamethasone, and ibuprofen on post-operative pain management in patients with single-level lumbar disc herniation surgery.. The present study was a randomized prospective study conducted at a tertiary university hospital. Sixty patients were equally divided into three groups based on whether they were treated with pregabalin (Group 1), ibuprofen (Group 2), and betamethasone (Group 3). Patients whose pre-operative back and leg pain was evaluated using a visual analog scale (VAS) and the Oswestry scale were administered 100 mg tramadol hydrochloride during surgery. The treatment efficiency was compared by assessing post-operative VAS scores at 24 h, 1 week, and 1 month after and Oswestry scale at 1 month after surgery.. The VAS scores for pre-operative and post-operative back pain did not show significant differences between the results at 1 week and 1 month in any group. There was no significant drug efficacy between post-operative week 1 and post-operative month 1, except for pregabalin; an early effect was less frequently observed in the pregabalin group than in the ibuprofen and betamethasone groups.. Although the three groups treated for single-level lumbar disc herniation received similar post-operative analgesia at the end of post-operative month 1, the decrease in VAS scores for back and leg pain was significant in the betamethasone group in the 1st post-operative 24 h and post-operative month 1.

Topics: Betamethasone; Humans; Ibuprofen; Intervertebral Disc Displacement; Lumbar Vertebrae; Pain, Postoperative; Pregabalin; Prospective Studies; Treatment Outcome

Preoperative oral pregabalin controls postoperative pain and decreases anesthetic requirements in total intravenous anesthesia. In this study, we hypothesized that preoperative pregabalin reduces inhaled isoflurane requirements.. We investigated the effectiveness of preoperative oral pregabalin 150 mg in women undergoing elective open total abdominal hysterectomy under general anesthesia. A prospective, randomized, double-blind, controlled study was conducted in a university hospital. The study included 50 women (18-60 yrs.), ASA I or II, admitted for abdominal hysterectomy under general anesthesia. Exclusion criteria were allergy to pregabalin; calcium channel blockers, antiepileptic drugs, antidepressant drugs, any analgesics, sedatives, or oral hypoglycemic agents. Patients were randomized into two groups; Pregabalin group received oral pregabalin 150 mg and placebo group. Main outcome measures was inhaled isoflurane requirements to maintain hemodynamics ±20% of baseline and bispectral index of 40 - 60, measured using MAQUET Flow-I anesthetic machine. Secondary outcomes were attenuation of pressor response to intubation, postoperative pain, and first time for rescue analgesia, total analgesics and adverse effects.. Isoflurane consumption was significantly less in pregabalin group (7.80±1.27 mL h -1) versus (12.27±2.49 mL h-1) in the control group, (P=0.00). Better hemodynamic stability was in pregabalin group. First postoperative hour: the mean VAS Score was significantly higher in control group (7.10±1.20) compared to pregabalin group (4.50±1.70), P<0.001. More dizziness was in pregabalin group.. Preoperative pregabalin 150 mg, 1 h before total abdominal hysterectomy has an inhaled anesthetic-sparing effect, maintain hemodynamics and optimizes postoperative analgesia.

Topics: Adult; Analgesics; Anesthesia, Inhalation; Anesthetics, Inhalation; Consciousness Monitors; Double-Blind Method; Female; Hemodynamics; Humans; Hysterectomy; Isoflurane; Middle Aged; Pain Measurement; Pain, Postoperative; Postoperative Nausea and Vomiting; Pregabalin; Prospective Studies; Treatment Outcome

Pregabalin as part of a multimodal pain-management regimen has been shown to reduce opioid consumption after spinal surgery in adults but it is unclear whether this is also true in adolescents. Pregabalin has been found to have neuroprotective effects and therefore could have a positive impact on pain after spinal deformity surgery. We conducted a randomized, double-blinded, placebo-controlled clinical trial of adolescent patients undergoing spinal fusion to evaluate the short-term effects of pregabalin on postoperative pain and opioid consumption.. Adolescents with adolescent idiopathic scoliosis, Scheuermann kyphosis, or spondylolisthesis who were scheduled for posterior spinal fusion with all-pedicle-screw instrumentation were randomized to receive either pregabalin (2 mg/kg twice daily) or placebo preoperatively and for 5 days after surgery. The patients ranged from 10 to 21 years of age. The primary outcome was total opioid consumption as measured with use of patient-controlled analgesia. Postoperative pain scores and opioid-related adverse effects were evaluated.. Sixty-three of 77 eligible patients were included and analyzed. Cumulative oxycodone consumption per kilogram did not differ between the study groups during the first 48 hours postoperatively, with a median of 1.44 mg/kg (95% confidence interval [CI],1.32 to 1.67 mg/kg) in the pregabalin group and 1.50 mg/kg (95% CI, 1.39 to 1.79 mg/kg) in the placebo group (p = 0.433). A subgroup analysis of 51 patients with adolescent idiopathic scoliosis showed the same result, with a mean of 1.45 mg/kg (95% CI, 1.24 to 1.65 mg/kg) in the pregabalin group and 1.59 mg/kg (95% CI, 1.37 to 1.82 mg/kg) in the placebo group (p = 0.289). Total oxycodone consumption per hour (mg/kg/hr) was not different between the groups over the time points (p = 0.752). The postoperative pain scores did not differ significantly between the groups (p = 0.196).. The use of perioperative pregabalin does not reduce the postoperative opioid consumption or pain scores in adolescents after posterior spinal fusion surgery.. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Topics: Adolescent; Adult; Analgesics; Analgesics, Opioid; Child; Double-Blind Method; Female; Humans; Male; Pain Measurement; Pain, Postoperative; Pregabalin; Spinal Fusion; Young Adult

In order to reduce postoperative opioid administration and pain levels in patients submitted to laparoscopic colectomy, we assessed the efficacy of preemptive use of pregabalin (PG), as part of a multimodal analgesia scheme, in a randomized controlled trial setting.. Overall, fifty adult patients scheduled for elective laparoscopic colectomy were included and randomized in our trial. In the experimental group, 23 patients received preoperatively 2 doses of 150 mg PG per os, whereas the control group consisted of 27 cases, where a matching to PG placebo was administered at the same scheme. The two groups had identical analgesia and anesthesia regimens otherwise. Our study endpoints included postoperative morphine consumption, postoperative pain, and complication rates.. Patients in the PG group displayed a significantly reduced morphine consumption at 8 h, 24 h, and 48 h postoperatively. The two groups were comparable in terms of postoperative pain (rest and movement assessment) and side effects.. The preoperative addition of PG resulted in a significant reduction of the postoperative opioid consumption in patients undergoing laparoscopic colectomy. However, an association with the postoperative pain scores was not identified.

Topics: Aged; Analgesics; Analgesics, Opioid; Colectomy; Drug Administration Schedule; Female; Greece; Humans; Laparoscopy; Male; Middle Aged; Morphine; Pain Management; Pain, Postoperative; Pregabalin; Premedication; Time Factors; Treatment Outcome

To determine the effectiveness of pregabalin and adductor canal block on opioid consumption, postoperative pain, and fast-tracking.. A total of 51 American Society of Anaesthesiologists (ASA) classification I–II patients aged 18–70 years who were scheduled to undergo elective anterior cruciate ligament reconstruction were included in the study. Patients were randomized into groups P, A, and C. Patients in group P (n = 16), received 150 mg of preoperative oral pregabalin, patients in group A (n = 17) received postoperative adductor canal blockade, and patients in group C (n = 18) received neither adductor canal block nor pregabalin. Surgeries were performed under spinal anaesthesia with hyperbaric bupivacaine following monitorization. Demographic data along with block features, hemodynamic data, mean opioid consumption, numerical rating scale score, White’s fast-track score, and postoperative adverse effects were recorded.. Fifty-seven patients were enrolled in the study, and 6 patients were excluded from the study; the data of 51 patients were included in the final analyses. Demographic characteristics and hemodynamic data were similar between the 3groups. Postoperative opioid consumption was significantly lower in groups A and P compared with group C (group P = 178.75 mg, group C = 318.61 mg, group A = 236.47 mg; P < 0.05). The regression of sensory block was significantly slower in group P (P < 0.05). The first analgesic requirement was earlier in group C than in groups P and A (P < 0.05). Patients in group P had higher fast-track scores at 8 h and 12 h compared with group C (P < 0.05); however, group A fast-track scores were similar to those of the other 2groups (P > 0.05). The rate of postoperative adverse effects was similar between the groups (P > 0.05).. Preoperative pregabalin (150 mg) reduced postoperative opioid consumption as much as adductor canal block in patients undergoing anterior cruciate ligament reconstruction. The first analgesic requirement was earlier in group C than in groups P and A. In addition, pregabalin can prolong the duration of spinal sensory block and shorten the time required to achieve high fast-tracking scores. We recommend the use of both methods as a part of multimodal analgesia.

Topics: Adult; Anterior Cruciate Ligament Reconstruction; Arthroscopy; Female; Humans; Male; Middle Aged; Nerve Block; Pain, Postoperative; Pregabalin; Prospective Studies

To assess the effect of perioperative pregabalin on pain behavior in dogs after intervertebral disc surgery.. Prospective, randomized, controlled clinical trial with a blinded observer.. Forty-six client-owned dogs undergoing intervertebral disc surgery.. Dogs were randomly assigned to two groups, with the placebo group receiving opioids alone and the pregabalin group receiving opioids plus pregabalin. Opioid analgesia consisted of 0.6 mg/kg l-methadone given intravenously at anesthetic induction, followed by 0.2 mg/kg given at 8, 16, and 24 hours after extubation and fentanyl patches applied at the end of surgery. Pregabalin was given orally (4 mg/kg) 1 hour before anesthesia, followed by postoperative treatment three times per day (4 mg/kg) for 5 days. The outcome measures were the treatment-group differences in peri-incisional mechanical sensitivity and Glasgow Composite Measure Pain Scale (CMPS-SF) assessed during the first 5 postoperative days. Pregabalin serum concentrations were measured after 24, 72, and 120 hours.. Pregabalin reduced pain levels in the treatment group by a mean of 2.5 CMPS-SF units (95% confidence interval [CI] = -3.19 to -1.83, P < .001) compared with the control group during the study period. Pregabalin increased the mechanical nociceptive threshold by a mean of 6.89 N per day (95% CI = 1.87-11.92, P < .001) and of 7.52 N per day (95% CI = 2.29-12.77, P < .001) during the study period, depending on location. Mean levels of serum pregabalin were 5.1, 4.71, and 3.68 μg/mL at 24, 72, and 120 hours postoperatively, respectively.. Postoperative signs of pain after surgical treatment of intervertebral disc herniation (IVDH) were reduced when dogs received perioperative pregabalin rather than opioids alone.. Perioperative pregabalin reduces postoperative pain after surgical treatment of IVDH.

Topics: Analgesics; Animals; Dog Diseases; Dogs; Female; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Male; Pain Management; Pain, Postoperative; Pregabalin; Prospective Studies

Reconstruction of the knee ligament causes postoperative pain and delayed rehabilitation.. The primary objective of this study was to evaluate the effect of a prolonged preoperative and postoperative pregabalin use for arthroscopic anterior cruciate ligament repair.. Group 1 (N=25) patients received pregabalin 75 mg/d, and group 2 (N=25) received placebo, 7 days before and 7 days after surgery. Spinal anesthesia was performed using 0.5% hyperbaric bupivacaine (15 mg). The following were evaluated: pain intensity immediately after the surgery, and 12 hours, 24 hours, 1 week, 2 weeks, 1 month, and 2 months after the surgery using a Numerical Rating Scale; dose of postoperative supplementary analgesic for 2 months; time to first analgesic requirement; and side effects during 2 months. For supplementation, the participants received 1 g dipyrone; if there was no pain control, 100 mg ketoprofen was administered; if there was no effect, 100 mg tramadol was administered; and if there was no pain control, 5 mg intravenous morphine was administered until pain control.. There was no difference between the groups with regard to pain intensity (P=0.077). In the pregabalin group, morphine consumption was lower at 12 hours (P=0.039) and 24 hours (P=0.044) after surgery, and the consumption of tramadol and ketoprofen was lower 24 hours after surgery. There was no significant difference in the incidence of nausea and vomiting. Dizziness was higher in the pregabalin group (group 1=12 patients; group 2=3 patients; P=0.005).. A prolonged preoperative and postoperative pregabalin prescription for anterior cruciate ligament repair decreased the need for supplementary analgesics during the first 24 postoperative hours but increased dizziness.

Topics: Analgesics; Anterior Cruciate Ligament; Double-Blind Method; Humans; Morphine; Pain, Postoperative; Pregabalin; Prospective Studies

Only few studies have yet investigated whether perioperative administration of pregabalin can reduce the incidence of postoperative chronic neuropathic pain after total hip arthroplasty (THA). This prospective, randomized study compared placebo with pregabalin in the hope that a lower pregabalin dose would improve analgesia without increasing side-effects after THA.. This study was a prospective randomized blinded study, with a parallel design and an allocation ratio of 1:1 for the treatment groups. The study was approved by the Institutional Review Board in Weifang People's Hospital and written informed consent was obtained from all subjects before enrolment. A total of 120 patients who meet inclusion criteria are randomized to either pregabalin or placebo group. The primary objective of the study was visual analog scale score. As secondary outcomes, opioid consumption measurement, Harris Hip Score, hip range of motion, patient satisfaction, and complications were made at different time points throughout the study for comparison.. The null hypothesis of this study was that pregabalin would reduce pain after THA.. This study protocol was registered in Research Registry (researchregistry5669).

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Analgesics; Arthroplasty, Replacement, Hip; Case-Control Studies; China; Double-Blind Method; Humans; Incidence; Middle Aged; Opioid-Related Disorders; Pain Management; Pain, Postoperative; Patient Satisfaction; Perioperative Care; Placebos; Pregabalin; Prospective Studies; Range of Motion, Articular; Visual Analog Scale; Young Adult

Topics: Analgesics; Breast Neoplasms; Double-Blind Method; Female; Humans; Pain, Postoperative; Pregabalin; Treatment Outcome

The goal of this study was to evaluate the effect of a single preoperative dose of 75 mg of pregabalin on postoperative pain in rhinoplasty. Volunteers with a physical status of ASA I were included in our study after informed written consent. This was a randomized, double-blinded, placebo-controlled clinical trial. All pregabalin and placebo capsules were given to patients orally 1 h prior to surgery. A standard open rhinoplasty procedure was performed on all patients. All patients underwent the same general anesthesia and postoperative analgesic protocol, with the only difference between the two studied groups being the use of a single dose of pregabalin prior to surgery. Finally, pain intensity was measured at 2, 4, 6, 12, and 24 h after surgery, using a horizontal visual analogue scale (VAS), and was analyzed statistically. 128 volunteers - 33 men (25.8%) and 95 women (74.2%) - with a mean age of 26.23 ± 7.16 were included in this study. Pain intensity scores were consistently lower in patients who received pregabalin preoperatively (p = 0.002); however, the incidence of nausea, drowsiness, difficulty in concentrating, dry mouth, and constipation showed no differences between the two study groups (p > 0.05). In conclusion, the administration of pregabalin should be added to the perioperative protocol whenever appropriate.

Topics: Analgesics; Double-Blind Method; Female; Humans; Male; Pain Measurement; Pain, Postoperative; Pregabalin; Prospective Studies; Rhinoplasty

To evaluate the usefulness of premedication with 75 mg pregabalin orally to reduce the degree of preoperative anxiety in patients scheduled for plastic surgery procedures.. A controlled randomized double-blind clinical trial that analyzed two groups of patients: 75 mg pregabalin tablet (Pg) against placebo tablet (Pl). Efficacy was assessed using the visual anxiety scale (VAS) with two measurements, the first without medication and the second 70 minutes after the drug was taken.. One hundred patients were evaluated, fifty received pregabalin and fifty placebo, baseline VAS score showed an general average of 4.6 ± 1.9 points, significantly higher in the Pg group (Pg 5.2 ± 2.1 points vs 4.1 ± 1.6 points Pl; p = 0.0035). The VAS score after premedication was 3.9 ± 2.1 points, significantly lower in the Pg group (Pg 3.2 ± 1.6 points vs 4.6 ± 2.3 Pl points, p = 0.0006).. Premedication 75 mg pregabalin orally decreases the degree of preoperative anxiety in adult patients scheduled for plastic surgery procedures.. Evaluar la utilidad de la premedicación con 75 mg de pregabalina por vía oral como dosis única para disminuir el grado de ansiedad preoperatoria en pacientes sometidos a cirugía plástica.. Ensayo clínico controlado, prospectivo, aleatorizado, doble ciego, que analizó dos grupos de pacientes: pregabalina tableta de 75 mg (grupo Pg) contra tableta placebo (grupo Pl). La eficacia se evaluó utilizando la escala visual de ansiedad (EVa) con dos mediciones, la primera sin medicación y la segunda 70 minutos después de tomar la cápsula.. Se evaluaron 100 pacientes: 50 que recibieron pregabalina y 50 placebo. La puntuación basal de la EVa mostró un promedio general de 4.6 ± 1.9 puntos, significativamente mayor en el grupo Pg (5.2 ± 2.1 puntos en Pg vs. 4.1 ± 1.6 puntos en Pl; p = 0.0035). El puntaje en la EVa posterior a la premedicación fue de 3.9 ± 2.1 puntos, significativamente menor en el grupo Pg (3.2 ± 1.6 puntos en Pg vs. 4.6 ± 2.3 puntos en Pl; p = 0.0006).. La premedicación con 75 mg de pregabalina disminuye el grado de ansiedad preoperatoria en pacientes que serán intervenidos de cirugía plástica.

Topics: Adult; Analgesics; Anxiety; Double-Blind Method; Humans; Pain, Postoperative; Pregabalin; Premedication; Surgery, Plastic; Treatment Outcome

Preventive analgesia is the administration of an analgesic drug with the aim of attenuating post-operative pain, hyperalgesia and allodynia. Its use is justified in order to offer analgesia and reduce anxiety in patients undergoing laparoscopic procedures.. To evaluate if pregabalin in a dose of 1 mg/kg of weight is effective as preventive analgesia in post-operated laparoscopic cholecystectomy patients.. A single-blind controlled clinical trial was conducted, which included 60 patients scheduled for laparoscopic cholecystectomy randomly divided into 2 groups, where Group 1 received placebo and Group 2 received pregabalin a daily dose 72 h prior to surgical intervention. The intensity of pain was assessed using the numeric analog scale at 1, 2, 6, 12 and 24 post-operative h, as well as the level of presurgical anxiety with the Hamilton scale.. Pain reduction was demonstrated in patients in the pregabalin group from the 1st h (p = 0.002), later the decrease in pain was more noticeable compared to patients who were given placebo (p < 0.001), the same happened with the anxiety level evaluated with the Hamilton scale (p < 0.005).. The use of pregabalin as preventive analgesia turns out to be effective in the post-operative period and the pre-operative anxiety with minimal adverse effects in the post-operated patients of laparoscopic cholecystectomy.

Topics: Adult; Analgesics; Anxiety; Cholecystectomy, Laparoscopic; Female; Humans; Hyperalgesia; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Placebos; Pregabalin; Single-Blind Method; Young Adult

Non-opioid medications as a part of multimodal analgesia has been increasingly suggested in the management of acute post-surgical pain. The present study was planned to compare the efficacy of the combination of pregabalin plus ıv ibuprofen.. 58 patients were included in this prospective, randomized, double-blinded study. The pregabalin group (Group P, n = 29) received 150 mg pregabalin, the pregabalin plus ibuprofen group (Gropu PI, n = 29) received 150 mg pregabalin and 400mg ıv ibuprofen before surgery. Postoperative fentanyl consumption, additional analgesia requirements and PACU stay were recorded. Postoperative analgesia was performed with patient-controlled IV fentanyl.. VAS scores in the group PI were statistically lower at PACU, 1and 2 hours at rest, at PACU, 1, 2, 4, 12 and 24 hours on movement compared to the group P (P < 0.05). Opioid consumption was statistically significantly higher in the group P compared to the group PI (130.17 ± 60.27 vs 78.45 ± 60.40 μq, respectively, P < 0.001) and reduced in the 4th 24 hours by 55% in group PI. Rescue analgesia usage was statistically significantly higher in the group P than in the group PI (16/29 vs 7/29, respectively, P < 0.001). Four patient in the group PI did not need any opioid drug. Besides, PACU stay was shorter in the group PI than the group P (10.62 ± 2.38 vs 15.59 ± 2.11 min, respectively, P < 0.001).. Preemptive pregabalin plus ıv ibuprofen in laparoscopic cholecystectomy reduced postoperative opioid consumption. This multimodal analgesic aproach generated lower pain scores in the postoperative period.

Topics: Administration, Intravenous; Adult; Aged; Analgesics, Opioid; Cholecystectomy, Laparoscopic; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Ibuprofen; Male; Middle Aged; Pain Management; Pain Measurement; Pain, Postoperative; Pregabalin; Preoperative Care; Prospective Studies; Treatment Outcome

Pregabalin has shown opioid sparing and analgesic effects in the early postoperative period; however, perioperative effects on cognition have not been studied. A randomized, parallel group, placebo-controlled investigation in 80 donor nephrectomy patients was previously performed that evaluated the analgesic, opioid-sparing, and antihyperalgesic effects of pregabalin. This article describes a secondary exploratory analysis that tested the hypothesis that pregabalin would impair cognitive function compared to placebo.. Eighty patients scheduled for donor nephrectomy participated in this randomized, placebo-controlled study. Pregabalin (150 mg twice daily, n = 40) or placebo (n = 40) was administered on the day of surgery and the first postoperative day, in addition to a pain regimen consisting of opioids, steroids, local anesthetics, and acetaminophen. Specific cognitive tests measuring inhibition, sustained attention, psychomotor speed, visual memory, and strategy were performed at baseline, 24 h, and 3 to 5 days after surgery, using tests from the Cambridge Neuropsychological Test Automated Battery.. In the spatial working memory within errors test, the number of errors increased with pregabalin compared to placebo 24 h after surgery; median (25th, 75th percentile) values were 1 (0, 6) versus 0 (0, 1; rate ratio [95% CI], 3.20 [1.55 to 6.62]; P = 0.002). Furthermore, pregabalin significantly increased the number of errors in the stop-signal task stop-go test compared with placebo; median (25th, 75th percentile) values were 3 (1, 6) versus 1 (0, 2; rate ratio, 2.14 [1.13 to 4.07]; P = 0.020). There were no significant differences between groups in the paired associated learning, reaction time, rapid visual processing, or spatial working memory strategy tests.. Perioperative pregabalin significantly negatively affected subdomains of executive functioning, including inhibition, and working memory compared to placebo, whereas psychomotor speed was not changed.

Topics: Analgesics; Analgesics, Opioid; Cognition; Cognition Disorders; Female; Humans; Male; Middle Aged; Pain, Postoperative; Perioperative Care; Pregabalin

Chronic postmastectomy pain syndrome (PMPS) has a considerable negative impact on the quality of life of breast cancer patients.. The objective of this study was to assess the possible preventive role of perioperative pregabalin in PMPS.. This randomized controlled study included 200 patients with breast cancer scheduled for elective breast cancer surgery. They were randomly assigned to one of two treatment groups. The pregabalin group received 75 mg of pregabalin twice daily for seven days and the control group received oral equivalent placebo capsules. The primary outcome was development of neuropathic PMPS. Neuropathic pain was assessed using the Grading System for Neuropathic Pain. Secondary outcome measures were safety and Visual Analogue Scale scores.. Neuropathic pain was significantly less frequent in the pregabalin group compared to the control group at four weeks (P = 0.005), 12 weeks (P = 0.002), and 24 weeks (P < 0.001) postoperatively. PMPS was diagnosed in 11 patients (11%) of the pregabalin group and 29 patients (29%) of the control group (P < 0.001, relative risk: 0.26, 95% CI: 0.12-0.56). At the three follow-up time points, Visual Analogue Scale scores during the first three postoperative weeks were comparable in both groups while they were significantly lower in the pregabalin group at 4, 12, and 24 weeks. These two groups were comparable in the frequency of adverse events (P = 0.552).. Perioperative oral pregabalin 75 mg twice daily, starting at the morning of surgery and continued for one week, could reduce the frequency of postmastectomy pain syndrome.

Topics: Administration, Oral; Analgesics; Breast Neoplasms; Double-Blind Method; Follow-Up Studies; Humans; Mastectomy; Middle Aged; Neuralgia; Pain, Postoperative; Pregabalin; Treatment Outcome

Surgical procedures involving the spine are known to cause moderate to severe postoperative pain. Inadequate management of acute pain in the postoperative period results in higher morbidity, and consequently may lead to chronic pain caused by central sensitization. The role of pre-emptive analgesia (PA) and intraoperative analgesia in management of postoperative pain has gained precedence over recent years. Pathophysiology of postoperative pain in spine surgery is unique, as it is a combination of nociceptive, inflammatory, and neuronal stimuli. Blockage of all three stimuli in the perioperative period by pre-emptively administrating a combination of paracetamol (P), ketorolac (K), and pregabalin (PR) might help in adequate management and alleviation of acute postoperative pain.. To evaluate the analgesic effect of a combination of P, K, and PR as pre-emptive multimodal analgesia, aimed to block or reduce acute postoperative pain after spine surgery.. A prospective, randomized, controlled, and double-blinded clinical trial.. After Institutional Review Board approval, 100 consecutive patients requiring single- or double level spinal fusion procedures were randomized into two groups-PA and control (C).. The PA group received P, K, and PR 4 hours before surgery, as PA. Both groups underwent identical anesthetic and postoperative pain management protocol.. Demographic and surgical data, 4 hourly postoperative pain levels-Numeric Pain Rating scale (NRS), Ambulatory NRS scores; level of consciousness-Ramsay sedation scale, total amount of opioids consumed (TOC) through patient-controlled analgesia; functional levels-Oswestry Disability Index (ODI), surgical satisfaction index-North American Spine Society (NASS) satisfaction scale, duration of hospital stay, and all complications were recorded and analyzed. A research grant of 6,032 USD was obtained from AO Spine toward this work. There is no conflict to disclose.. Both the groups had identical demographic backgrounds and surgical profiles. The average NRS score within the first 48-hour period in the PA group (2.7±0.79) was significantly less than the C group (3.4±0.98) and the differences were more in the first 12 hours following surgery. Similarly, Ambulatory NRS scores were significantly low in the PA group during the first and second postoperative days. The PA group individuals were found to be more physically motivated, as 95.7% were able to ambulate 50 m on the first postoperative day compared with 30% in the C group. The PA group had significantly low TOC (3.02±2.29 mg) in comparison to the C group (4.94±3.08 mg). The duration of hospital stay was 4.17±1.02 and 4.84±1.62 days in the PA and C groups (p=.017), respectively. No major complications occurred in either groups and were found to be similar in percentage between both the groups, except for nausea and vomiting which were more in C group. Dry mouth was the most common side effect noted irrespective of the groups. All patients had significant improvement in ODI with better results in PA group at first month follow up. The PA group (97.90%) was extremely satisfied compared with C group (72%, p=.002) according to NASS scale.. Postoperative pain management in spine surgery is maximized if perioperative painful stimuli can be inhibited, which requires adequate blood levels of analgesic, anti-inflammatory, and neuropathic drugs intraoperatively. The employed strategy of preoperative administration of balanced analgesia with a combination of P, K, and PR, each having different mechanisms of action, resulted in lesser pain intensity, allowed better ambulation tolerance, improved functional outcomes and has also reduced the requirement of opioids and duration of hospital stay with no additional complications. Thus, this balanced analgesia administered preoperatively would address the complicated postsurgical pain.

Topics: Acetaminophen; Adult; Aged; Analgesics; Anti-Anxiety Agents; Anti-Inflammatory Agents, Non-Steroidal; Drug Combinations; Female; Humans; Ketorolac; Male; Middle Aged; Pain, Postoperative; Pregabalin; Spinal Fusion

Opioid exposure is a concern after live donation for kidney transplant. We theorized that an enhanced recovery after surgery pathway (ERAS) using pregabalin preoperatively to desensitize nerves followed by the nonsteroidal anti-inflammatory drug ketorolac, during and after surgery, can control pain, thus requiring less perioperative narcotics. The aim of this study was to determine if the use of a nonopioid analgesic ERAS protocol for donor nephrectomies could decrease the use of narcotics without an increase in complications compared with standard of care (SOC). This is a single-center, prospective, double-blind, randomized clinical trial involving a total of 62 patients undergoing nephrectomy for live donor kidney transplant. Length of hospital stay (LOS) was significantly reduced by 10% in the ERAS group versus the SOC-plus-placebo group. Morphine dose equivalents were significantly reduced by 40% in the study group versus the SOC-plus-placebo group. The use of this nonopioid analgesic ERAS pathway for donor nephrectomies decreased the use of narcotics without an increase in complications compared with SOC. There was significantly reduced LOS and less narcotic use in the study group versus the SOC-plus-placebo group. (ClinicalTrials.gov registration number: NCT03669081).

Topics: Adult; Analgesics; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Double-Blind Method; Enhanced Recovery After Surgery; Female; Hand-Assisted Laparoscopy; Humans; Ketorolac; Kidney Transplantation; Length of Stay; Living Donors; Male; Middle Aged; Nephrectomy; Pain, Postoperative; Pregabalin; Prospective Studies; Standard of Care; Tissue and Organ Harvesting

Background and aims Pain is the most common reason for delayed discharge after day-case laparoscopic cholecystectomy. This study investigates a simple five-item questionnaire in evaluating the risk of postoperative pain in day-case cholecystectomy and the efficacy and safety of single-dose preoperative pregabalin on patients with multiple risk factors for pain. There are no previous studies on targeting adjuvant pain treatment based on the individual risk factors like the preoperative state of anxiety, acute or chronic pain, and the expectation of pain in day-case surgery. Methods One hundred and thirty patients scheduled for day-case laparoscopic cholecystectomy were evaluated with a five-item questionnaire assessing the risk for postoperative pain. The patients with multiple risk factors (n=60) were randomized to receive either pregabalin 150 mg or placebo, 1 h before surgery. The primary outcome was abdominal pain intensity on numerical rating scale (NRS) 1 h after surgery. Pain, analgesic consumption and adverse effects during first three postoperative days, and the length of hospital stay were also recorded. Results Pregabalin 150 mg given as an adjuvant analgesic preoperatively did not decrease postoperative abdominal pain or opioid consumption in the first hour after surgery compared to placebo in a preselected group of patients with multiple risk factors for postoperative pain (p=0.31). Preoperative anxiety assessed with a scale of 0-10 had a positive association with postoperative pain (p=0.045). Conclusions and implications This was the first trial on systematically selecting patients with a high-risk factor profile for postoperative pain as a target for a preventive adjuvant analgesic intervention. Although numerous previous studies have identified various risk factors, including those used in the current trial, it seems to be challenging to use these risk factors as predictive tools for targeting adjuvant analgesics in day-case surgery. Preoperative anxiety has a positive association with postoperative pain in day-case laparoscopic cholecystectomy, and this should be taken into account when treating these patients.

Topics: Adjuvants, Pharmaceutic; Ambulatory Surgical Procedures; Analgesics; Cholecystectomy, Laparoscopic; Double-Blind Method; Female; Fentanyl; Finland; Humans; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Pregabalin; Risk Factors; Surveys and Questionnaires

The objective of this study was to investigate the effects of the preoperative combination of oral Pregabalin and intravenous (IV) magnesium sulfate as analgesic adjuvants in postthoracotomy pain.. One hundred twenty patients with American Society of Anesthesiologists physical status II were allocated randomly into 1 of 4 groups. Group MP received 300 mg pregabalin orally and an IV infusion of magnesium sulfate 50 mg/kg mixed with 200 mL normal saline (NS); group P received 300 mg pregabalin orally and 200 mL NS infusion; group M received an IV infusion of magnesium sulfate 50 mg/kg mixed with 200 mL NS and a placebo capsule; and group C received placebo capsule and an IV infusion of 200 mL NS. All medications were given 1 hour before surgery in all groups. In the first 24 hours postoperatively, total morphine consumption, the Visual Analog Scale (0 to 10)-used as a pain measurement tool-and postoperative nausea and vomiting were assessed.. The total morphine consumption in the first 24 hours postoperatively decreased significantly in group MP (28.47±5.76 mg) compared with group P (33.97±6.34 mg), group M (40.87±4.4 mg), and group C (42.2±6.1 mg), respectively. VAS scores were in the accepted range (≤4) in the 4 groups throughout the first 24 hours, as all patients were on patient-controlled analgesia. However, there was a statistically significant difference at 0 and 4 hours postoperatively in favor of groups MP and P. Postoperative nausea and vomiting decreased significantly in groups MP, P, and M in comparison with group C (P<0.001).. The combined preoperative single dose of pregabalin and magnesium sulfate is an effective method for attenuating postoperative pain and total morphine consumption in patients undergoing thoracotomy.

Topics: Administration, Intravenous; Administration, Oral; Analgesia, Patient-Controlled; Analgesics; Child; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Magnesium Sulfate; Male; Morphine; Pain, Postoperative; Postoperative Nausea and Vomiting; Pregabalin; Thoracotomy

The purpose of this prospective, randomized, double-blinded, placebo-controlled study was to determine if pregabalin, when given perioperatively in addition to patient-controlled analgesia morphine, paracetamol and etoricoxib, is effective in reducing morphine requirements and moderating pain scores after primary total knee arthroplasty. We hypothesize that there would be no difference in postoperative opioid requirements, postoperative pain scores, and functional scores with the use of perioperative pregabalin.. Eighty-seven patients who underwent primary total knee arthroplasty were randomised and allocated to two groups. One group received capsules containing pregabalin 75 mg, and the other a placebo-one capsule before surgery and one capsule once per night up till postoperative day 2. Multimodal analgesia provided for all patients in this study included femoral nerve block, intravenous patient-controlled analgesia (morphine), paracetamol and etoricoxib. The primary outcome of patient's pain control was based on the measurement of cumulative morphine consumption during the first 72 h postoperatively.. Pregabalin did not reduce the cumulative or effective morphine consumption at 48 h and 72 h post-operation. There were also no significant differences noted in pain scores at 48 h and 72 h after surgery, functional range of motion of the operated knee at 72 h post-op, or outcomes recorded on the Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and 36-Item Short Form Survey (SF-36) questionnaires at 3 and 6 months post-op. None of the patients demonstrated common adverse reactions to pregabalin.. This study showed no reduction in postoperative opioid requirements, or improvement in early postoperative pain scores or functional outcomes at 6 months, with perioperative use of pregabalin. Orthopaedic surgeons may consider this when selecting an analgesic regimen for their patients.. II.

Topics: Aged; Aged, 80 and over; Analgesia, Patient-Controlled; Analgesics, Opioid; Arthroplasty, Replacement, Knee; Double-Blind Method; Female; Humans; Knee Joint; Male; Middle Aged; Morphine; Pain Measurement; Pain, Postoperative; Postoperative Period; Pregabalin; Prospective Studies; Range of Motion, Articular

Persistent postsurgical pain is defined as pain localized to the area of surgery of a duration of ≥2 months and is, unfortunately, a common complication after breast cancer surgery. Although there is insufficient evidence to support any preventative strategy, prior literature suggests the possible efficacy of intravenous lidocaine and perioperative pregabalin in preventing persistent pain after surgery. To determine feasibility of conducting a larger definitive trial, we conducted a multicenter 2 × 2 factorial, randomized, placebo-controlled pilot trial of 100 female patients undergoing breast cancer surgery. Patients were randomized to receive an intraoperative lidocaine infusion (1.5 mg/kg bolus followed by 2 mg/kg/h) or placebo and perioperative pregabalin (300 mg preoperatively, 75 mg twice daily for 9 days) or placebo. All feasibility criteria were surpassed; recruitment of 100 patients was accomplished within 42 weeks, with a follow-up rate of 100% and study drug compliance of ≥80%. At 3 months, 53% of patients reported persistent neuropathic pain. Although there was no interaction between lidocaine and pregabalin, lidocaine decreased the development of persistent neuropathic pain (43.1% vs 63.3%; relative risk = .68; 95% confidence interval = .47-1.0). Pregabalin did not reduce persistent pain (60% vs 46%; relative risk = 1.3; 95% confidence interval = .90-1.90) and neither pregabalin nor lidocaine impacted acute postoperative pain, opioid consumption, pain interference, or quality of life. Our pilot trial successfully demonstrated feasibility and provided promising data for conducting further trials of intraoperative lidocaine infusions during breast cancer surgeries. Clinical trial number: NCT02240199 PERSPECTIVE: This article reports the findings of a pilot randomized, controlled trial evaluating the effects of perioperative pregabalin and intraoperative lidocaine infusions in patients undergoing breast cancer surgery. This trial demonstrated the feasibility of conducting a larger trial and provided promising data that these interventions may decrease the development of persistent pain.

Topics: Adult; Aged; Analgesics; Anesthetics, Local; Breast Neoplasms; Double-Blind Method; Female; Humans; Intraoperative Care; Lidocaine; Mastectomy; Mastectomy, Segmental; Middle Aged; Neuralgia; Pain, Postoperative; Pilot Projects; Pregabalin; Treatment Outcome

The objective of this study was to compare the efficacy of different doses of pregabalin and intravenous ibuprofen with regard to pain management and analgesic consumption after third molar surgery.. Ninety patients who had been scheduled for third molar surgery were assigned to four different treatment groups. The inclusion criteria consisted of the presence of fully or partially bony retentive asymptomatic mandibular third molars. These groups are included the following: (Group 1) premedicated with oral placebo and intravenous (IV) placebo, (Group 2) premedicated with oral placebo and 400-mg IV Ibuprofen, (Group 3) premedicated with 75-mg oral pregabalin and 400-mg IV ibuprofen, and (Group 4) premedicated with 150-mg oral pregabalin and 400 mg IV ibuprofen. Postoperative pain was assessed with visual analog scale (VAS) every hour for the first 12 hs following the surgery. Pain was then assessed at different time intervals during 7 days following the surgery. Kruskal-Wallis tests were used to compare the four groups in terms of VAS pain scores, analgesic consumption, and first rescue analgesic request time after the surgery.. At the end of the study, the results of 80 patients (20 patients per group) were analyzed. The group 4 had lower pain intensity compared with other groups at various time intervals. This difference is statistically significant in between the first 3-10 h (first day) and single-time intervals in second, third, fifth, and sixth postoperative days. Postoperative analgesic consumption was not statistically different between the groups. The first rescue analgesic request time after surgery was different between the pregabalin combination groups and group 2. No significant difference in the side effects was observed.. These findings suggest that preoperative coadministration of 150-mg pregabalin and IV ibuprofen may be useful in improving pain control after third molar surgery.

Topics: Administration, Intravenous; Administration, Oral; Adolescent; Adult; Analgesics; Double-Blind Method; Female; Humans; Ibuprofen; Male; Molar, Third; Pain Management; Pain, Postoperative; Pregabalin; Preoperative Period; Tooth Extraction; Treatment Outcome; Visual Analog Scale

A single perioperative dose of glucocorticoid or gabapentinoid, or a combination of the 2, may improve postoperative analgesia, but data are still insufficient to be conclusive. In this single-center, randomized, double-blind, and double-dummy trial, we aimed to test whether the analgesic effect of adding preoperative pregabalin, at a dose unlikely to induce side effects, to preoperative dexamethasone improves early mobilization after spinal surgery.. A total of 160 patients undergoing scheduled lumbar disk surgery (145 analyzed) comprised the study cohort. The patients received either 0.2 mg/kg intravenous dexamethasone before incision, or 150 mg oral pregabalin 1 hour before surgery, or a combination of the 2, or none of the above (control). Analgesia was supplemented by acetaminophen and ketoprofen, plus oxycodone ad libitum. The primary outcome was pain intensity during the first attempt to sit up, assessed the morning of the first postoperative day on an 11-point Numerical Rating Scale. Pain at rest and when standing up, opioid consumption, and tolerance were also assessed.. None of the treatments tested differed from the control group in terms of efficacy or tolerance, even 6 months after surgery. The overall quality of analgesia was good, with only 10% and 30% of pain scores exceeding 3/10 for pain at rest and during movement, respectively.. In this surgical model with the given anesthetic and analgesic environment, there was no advantage gained by adding low-dose pregabalin or dexamethasone. The multimodal analgesic protocol applied to all patients may have reduced the size of the effect.

Topics: Adult; Analgesia; Analgesics; Dexamethasone; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Middle Aged; Orthopedic Procedures; Pain Management; Pain Measurement; Pain, Postoperative; Pregabalin

To evaluate the efficacy of single low dose (75 mg) preoperative pregabalin in reducing post-operative pain of septorhinoplasty.. A double blind single center Randomized controlled trial based on block randomization. In the pregabalin group (PG) 34 participants received 75 mg pregabalin orally one hour before anesthesia induction while in control group (CG) 34 participants received a placebo. Pain and sedation were repeatedly measured with Visual Analouge Scale (VAS) and Riker Sedation-Agitation Scale (RSAS) respectively, 0.5, 1, 2, 6, 24 hours postextubation. Cumulative doses of fentanyl and ibuprofen received in both groups were compared.. Thirty-two of the participants in PG and 33 of the participants in CG completed the study. The Mean VAS pain score was less in PG versus CG 30 min postoperatively (2.30 ± 1.30 vs. 4.85 ± 1.17), one hour (2.28 ± 0.92 vs. 4.27 ± 0.78), two hours (2.11 ± 0.88 vs. 3.60 ± 0.61) and six hours (1.47 0.62 vs. 2.76 ± 0.91) but not 24-hours postoperatively (0.84 ± 0.62 vs. 1.09 ± 0.92). Participants in the PG were less agitated during early post-extubation period (at 10 min: RSAS 3.93 ± 0.43 vs. 4.42 ± 0.50) and more alert during the first hour post-extubation (at 60 min: RSAS 3.90 ± 0.29 vs. 3.36 ± 0.69). The total dose of rescue fentanyl and ibuprofen was lower in the PG compared to the CG.. A single dose of 75 mg pregabalin is very effective for pain control after septorhinoplasty procedure when administered one hour before anesthesia induction. Side effects are rare and opioid sparing was noted.. Clinical trial number: IRCT2017043033706N1.

Topics: Analgesics; Analgesics, Opioid; Double-Blind Method; Female; Fentanyl; Humans; Ibuprofen; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Pregabalin; Rhinoplasty; Time Factors; Treatment Outcome

Persistent postsurgical pain is common and affects quality of life. The hypothesis was that use of pregabalin and ketamine would prevent persistent pain after cardiac surgery.. This randomized, double-blind, placebo-controlled trial was undertaken at two cardiac surgery centers in the United Kingdom. Adults without chronic pain and undergoing any elective cardiac surgery patients via sternotomy were randomly assigned to receive either usual care, pregabalin (150 mg preoperatively and twice daily for 14 postoperative days) alone, or pregabalin in combination with a 48-h postoperative infusion of intravenous ketamine at 0.1 mg · kg · h. The primary endpoints were prevalence of clinically significant pain at 3 and 6 months after surgery, defined as a pain score on the numeric rating scale of 4 or higher (out of 10) after a functional assessment of three maximal coughs. The secondary outcomes included acute pain, opioid use, and safety measures, as well as long-term neuropathic pain, analgesic requirement, and quality of life.. In total, 150 patients were randomized, with 17 withdrawals from treatment and 2 losses to follow-up but with data analyzed for all participants on an intention-to-treat basis. The prevalence of pain was lower at 3 postoperative months for pregabalin alone (6% [3 of 50]) and in combination with ketamine (2% [1 of 50]) compared to the control group (34% [17 of 50]; odds ratio = 0.126 [0.022 to 0.5], P = 0.0008; and 0.041 [0.0009 to 0.28], P < 0.0001, respectively) and at 6 months for pregabalin alone (6% [3 of 50]) and in combination with ketamine 0% (0 of 5) compared to the control group (28% [14 of 50]; odds ratio = 0.167 [0.029 to 0.7], P = 0.006; and 0.000 [0 to 0.24], P < 0.0001). Diplopia was more common in both active arms.. Preoperative administration of 150 mg of pregabalin and postoperative continuation twice daily for 14 days significantly lowered the prevalence of persistent pain after cardiac surgery.

Topics: Aged; Analgesics; Cardiac Surgical Procedures; Chronic Pain; Double-Blind Method; Female; Follow-Up Studies; Humans; Ketamine; Male; Middle Aged; Pain, Postoperative; Perioperative Care; Pregabalin; Prospective Studies; Time; United Kingdom

Preventive analgesia is the administration of an analgesic drug with the aim of attenuating post-operative pain, hyperalgesia and allodynia. Its use is justified in order to offer analgesia and reduce anxiety in patients undergoing laparoscopic procedures.. To evaluate if pregabalin in a dose of 1 mg/kg of weight is effective as preventive analgesia in post-operated laparoscopic cholecystectomy patients.. A single-blind controlled clinical trial was conducted, which included 60 patients scheduled for laparoscopic cholecystectomy randomly divided into 2 groups, where Group 1 received placebo and Group 2 received pregabalin a daily dose 72 h prior to surgical intervention. The intensity of pain was assessed using the emergency nurses association scale at 2, 6, 12 and 24 post-operative h, as well as the level of presurgical anxiety with the Hamilton scale.. Pain reduction was demonstrated in patients in the pregabalin group from the 1. The use of pregabalin as preventive analgesia turns out to be effective in the post-operative period and the pre-operative anxiety with minimal adverse effects in the post-operated patients of laparoscopic cholecystectomy.. La analgesia preventiva es la administración de un fármaco analgésico con el objetivo de atenuar el dolor postoperatorio, la hiperalgesia y alodinia. Está justificado su uso con la finalidad de ofrecer analgesia y disminuir la ansiedad a los pacientes sometidos a procedimientos laparoscópicos.. Evaluar si la pregabalina en dosis de 1 mg/kg de peso es eficaz para analgesia preventiva en pacientes postoperados de colecistectomía laparoscópica.. Se realizó un ensayo clínico controlado ciego simple que incluyó 60 pacientes programados para colecistectomía laparoscópica divididos en 2 grupos de manera aleatoria, donde al grupo 1 se administró placebo y al grupo 2 se le administró pregabalina una dosis diaria 72 horas previas a la intervención quirúrgica. La intensidad del dolor se evaluó mediante la Escala Numérica Analógica a la hora, 2, 6,12 y 24 horas postoperatorias, así como el nivel de ansiedad prequirúrgico con la Escala de Hamilton.. Se demostró disminución del dolor en los pacientes del grupo de pregabalina desde la primera hora (p = 0.002), posteriormente fue más notorio el descenso del dolor en comparación con los pacientes a los que se les dio placebo, con valor estadísticamente significativo (p < 0.001), lo mismo sucedió con el nivel de ansiedad evaluada con la Escala de Hamilton (p < 0.005).. El uso de pregabalina para analgesia preventiva resulta ser eficaz en la ansiedad preoperatoria y el periodo posquirúrgico, y con mínimos efectos adversos, en los pacientes operados de colecistectomía laparoscópica.

Topics: Adult; Analgesia; Analgesics; Anxiety; Cholecystectomy, Laparoscopic; Female; Humans; Male; Middle Aged; Pain, Postoperative; Pregabalin; Preoperative Care; Single-Blind Method

The aim of this study was to evaluate the effect of preoperative pregabalin on postoperative analgesia in patients undergoing radiofrequency ablation (RFA) of hepatic focal lesions (HFLs).. This randomised controlled study was carried out on 70 adult patients for whom RFA was indicated to treat hepatocellular carcinoma. They were randomised into two groups: Group I: 35 patients who were given a placebo before the procedure and Group II: 35 patients who were given 150 mg of oral pregabalin one hour before the procedure. The primary outcome was the analgesic effect in the form of postoperative pain severity and the need for opioid analgesics.. In the immediate postoperative period there was no significant difference between the two groups on pain assessment by the visual analogue pain scale (VAS Pain; p = 0.84). However, the medians of Group II VAS Pain were significantly (p < 0.001) less than Group I 3,2,1,1,1,0 vs. 4,3,3,2,2,2, respectively when measured every four hours until 24 hours. The number of required doses of rescue analgesia and total required dose of morphine in the first 48 hours postoperatively of Group II were significantly (p < 0.001) less than Group I. Side effects such as nausea and vomiting and delayed discharge were significantly less frequent in Group II when compared with Group I:20vs. 45.7%, 17.1 vs. 45.7% and 11.4 vs. 37.1%, respectively (p = 0.02, 0.01 and 0.01, respectively).. Pre-emptive oral pregabalin is safe and effective for postoperative analgesia in patients scheduled for radiofrequency ablation of focal lesions in liver.

Topics: Adult; Analgesia; Analgesics; Carcinoma, Hepatocellular; Female; Humans; Liver Neoplasms; Male; Middle Aged; Pain, Postoperative; Pregabalin; Preoperative Care; Radiofrequency Ablation

Background Pregabalin is a gamma-aminobutyric acid analog which seems to be effective in different neuropathic pains, as well as in incisional and inflammatory injuries. This study evaluated the effectiveness and safety of pregabalin on pain relief post herniorrhaphy. Methods In this randomized clinical trial, 60 men were chosen for unilateral inguinal herniorrhaphy under spinal anesthesia. The participants were randomly divided into two groups. The investigation (pregabalin) group received 300 mg of oral pregabalin 2 h before and 150 mg of pregabalin 12 and 24 h after surgery in addition to routine postoperative medication and 1 mg/kg of pethidine as needed. The control (placebo) group received placebo capsules similar to the investigation group, as well as routine medication and 1 mg/kg of pethidine as needed. All surgeries were done with the same technique. Post-surgery pain was evaluated in the walking and lying positions with a visual analog scale at 12 and 24 h and at 3 and 7 days after the surgery. Pethidine consumption and adverse effects of pregabalin were also assessed. Results The investigation group had less pain and lower visual analog scale scores at 12 and 24 h and also at 3 days after surgery and consumed less pethidine compared to the control group (p<0.05). Conclusions Pregabalin reduces pain and opioid consumption in the first 3 days after surgery. The adverse effects of pregabalin are limited to the first 12 h after surgery. Pregabalin can be suggested for pain relief, but it should be used with caution in the elderly.

Topics: Administration, Oral; Analgesics, Opioid; Anesthesia, Spinal; Herniorrhaphy; Humans; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Pregabalin

Surgical trauma is known to induce hyperalgesia, and if pain management is insufficient, it contributes to persistent pain in the postoperative period.In this study, our primary aims were to compare the effect of pregabalin and duloxetine on postoperative pain scores and cognitive functions. Our secondary aim was to determine drug-related side effects.. This was a prospective, randomized, double-blind, placebo-controlled study.. The study was carried out in the setting of the operating room and the surgical ward.. Ninety-four patients, 18 to 65 years of age, ASA status I-II, scheduled for elective repair of lumbar disc herniation were enrolled in the study.. The patients were randomly divided into 3 groups: the first group received pregabalin 75 mg orally 1 hour before the surgery and at the postoperative 12th and 24th hours. The second group received duloxetine 60 mg orally 1 hour before the surgery. At the postoperative 12th hour, they received a placebo capsule, and, at the 24th hour, they received duloxetine 60 mg again. The third group received placebo capsules orally at all timepoints.. Postoperative pain evaluation was conducted using a Visual Analogue Scale at the postoperative first minute, 30th minute, first hour, and the 12th, 24th, and 48th hours. The preoperative and postoperative sixth hour cognitive functions were evaluated with Montreal Cognitive Assessment (MoCA) test.. There was a significant reduction in mean MoCA scores postoperatively in all groups (P<0.01). The highest MoCA score reduction was in the pregabalin group (1.83±1.31 point), then in the duloxetine group (1.16±0.82), and the least decrease was in the control group (0.49±0.61). At all timepoints, the mean Visual Analogue Scale scores of the pregabalin and duloxetine groups were similar to each other, and they were lower than that of the control group (P<0.05).. Preoperative use of duloxetine 60 mg can be an useful alternative to pregabalin 75 mg, as it has a similar analgesic effect on postoperative pain, with fewer incidences of drug-related negative effects on cognitive function.

Topics: Adolescent; Adult; Aged; Analgesics; Cognition; Double-Blind Method; Duloxetine Hydrochloride; Female; Humans; Intervertebral Disc Displacement; Male; Middle Aged; Orthopedic Procedures; Pain Management; Pain Measurement; Pain, Postoperative; Pregabalin; Spine; Treatment Outcome; Young Adult

Gabapentinoids are increasingly used in preoperative premedication despite controversial results. The aim of our study was to evaluate the effects of preemptive use of gabapentin or pregabalin on postoperative shoulder pain and rehabilitation quality after laparoscopic cholecystectomy.. This is a clinical trial comparing the effects of a preoperative premedication with 600 mg of gabapentin or 150 mg of pregabalin versus placebo on postoperative pain and recovery quality after laparoscopic cholecystectomy. Premedication was taken 2 hours before the surgery beginning. Ninety patients were included and randomized into 3 groups (gabapentin, pregabalin, and placebo). The anesthetic protocol was the same for all patients. Primary endpoint was the shoulder pain intensity at the 48th postoperative hour. Secondary endpoints were postoperative nausea and vomiting (PONV), sleep quality during the first night, and the onset time for the first standing position.. During the first 48 postoperative hours, the gabapentin and pregabalin groups had significantly lower shoulder pain than the placebo group (. Preemptive premedication with gabapentinoids can enhance postoperative rehabilitation quality after laparoscopic cholecystectomy by reducing postoperative shoulder pain, decreasing PONV incidence, and improving sleep quality during the first postoperative night. This trial is registered with ClinicalTrial.gov (NCT03241875).

Topics: Adult; Analgesics; Cholecystectomy; Cyclohexanecarboxylic Acids; Female; Gabapentin; gamma-Aminobutyric Acid; Humans; Male; Middle Aged; Pain, Postoperative; Pregabalin; Shoulder Pain; Treatment Outcome

The growing need for symptomatic treatment of post-traumatic neuropathic pain (PTNP) continues to be unmet. Studies evaluating the efficacy of pregabalin for reducing neuropathic pain following trauma and surgery yielded positive results over ≤ 8-week treatment. To assess the efficacy and tolerability of pregabalin over 3 months in patients with PTNP, a randomized, double-blind, placebo-controlled, parallel-group trial evaluated patients with PTNP at 101 centers in 11 countries-the longest, largest such trial. Adults diagnosed with PTNP were randomly assigned (1:1) to 15 weeks of pregabalin (flexibly dosed 150-600 mg/day) or matching placebo. Primary efficacy analysis was by mixed-model repeated measures comparing change from baseline to week 15 in weekly mean pain scores between active and placebo groups. Evaluable patients included 274 in the pregabalin group and 265 in the placebo group. Trauma was surgical in 49.6% of patients, non-surgical in the remainder. The primary efficacy analysis showed no statistically significant difference between pregabalin and placebo groups in the change from baseline to week 15 [mean difference, - 0.22 points (95% confidence interval, 0.54-0.10); p = 0.1823]. However, comparisons for key secondary outcome measures yielded p values < 0.05 favoring pregabalin. Consistent with the known safety profile of pregabalin, the most common adverse events were dizziness and somnolence (14.6 and 9.9% of patients, respectively) with pregabalin (vs 4.2 and 3.4% with placebo). These findings demonstrate the feasibility of conducting a large, phase 3 registration trial in the heterogeneous PTNP study population.ClinicalTrials.gov NCT01701362.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Analgesics; Double-Blind Method; Female; Humans; Male; Middle Aged; Neuralgia; Pain, Postoperative; Pregabalin; Treatment Outcome; Wounds and Injuries; Young Adult

Pregabalin and dexmedetomidine have been introduced to manage postoperative pain. This study evaluated the effect of the 2 drugs combined on pain in patients undergoing total knee or hip arthroplasty. A total of 124 patients undergoing total knee or hip arthroplasty under spinal anesthesia were randomly assigned to either group C (n=31, placebo), group P (n=33, pregabalin), group PD (n=29, pregabalin and dexmedetomidine), or group D (n=31, dexmedetomidine). One hour before spinal anesthesia, patients received 150 mg of pregabalin or placebo orally, and a bolus dose of 0.5 µg/ kg of intravenous dexmedetomidine was given over 10 minutes before induction of spinal anesthesia. This was followed by a continuous infusion of 0.5 µg/kg/h or the same calculated volume of normal saline until completion of the surgery. Clinically relevant pain for 24 hours postoperatively, including time to first analgesic request, visual analog scale score, ketorolac dose, and volume of patient-controlled analgesia consumed, was recorded. Group C had significantly longer time to first analgesic request, higher visual analog scale scores at rest and on movement, higher ketorolac dose, and higher volume of patient-controlled analgesia for the first 24 hours postoperatively compared with the other groups. Although group PD and group D had less clinically relevant pain than group P, group PD and group D were not significantly different. Dexmedetomidine was more effective than pregabalin for clinically relevant pain. Pregabalin and dexmedetomidine combined had no synergic effect compared with dexmedetomidine alone. [Orthopedics. 2018; 41(6):365-370.].

Topics: Aged; Analgesia, Patient-Controlled; Analgesics, Non-Narcotic; Anesthesia, Spinal; Anti-Inflammatory Agents, Non-Steroidal; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Dexmedetomidine; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Ketorolac; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Pregabalin

The study aimed to investigate the preemptive analgesia efficacy of different concentrations (75, 150 and 300mg) of preemptive pregabalin for the postoperative pain management after laparoscopic hysterectomy.. Prospective, randomized, placebo-controlled, double-blind study.. The Gynecology and Obstetrics Center of Arash Hospital, Tehran, Iran, from October 2013 to November 2014.. A total of 96 women with American Association of Anesthesiologist (ASA) physical status I and II underwent elective laparoscopic hysterectomy surgery. Patients were then randomly assigned to four groups, of which groups 1-3 (treatment groups; n=20) received orally pregabalin concentrations of 75mg, 150mg, and 300mg, respectively, for a night before surgery, 30min before surgery and 6h after surgery, whereas group 4 (control group; n=22) received a matching dosage of placebo at the same scheme.. Visual Analog Scale (VAS) scores for postoperative pain at rest and on movement at first 24h after surgery were evaluated as primary outcome. Drug-related side effects were also evaluated as a secondary outcome. Somnolence was evaluated using Ramsay Sedation Scale, while nausea and vomiting were assessed using numeric scores. The data were analyzed using SPSS.. Preemptive pregabalin in different concentrations provided better pain relief as compared with placebo. Post-hoc test indicated that there was a significant difference among four groups, indicating where the concentration was increased, the pain score decreased as an independent variable of time. The highest concentration of pregabalin (300mg) revealed higher sedation scores as compared with other groups.. Our data demonstrated preemptive administration of 75, 150, and 300mg pregabalin play an important role in reducing postoperative pain after laparoscopic hysterectomy. Comparison of different concentrations and side effects indicates oral administration of 150mg pregabalin is an effective and safe method for postoperative pain management after laparoscopic hysterectomy.

Topics: Administration, Oral; Adult; Analgesics; Dizziness; Dose-Response Relationship, Drug; Double-Blind Method; Female; Humans; Hysterectomy; Iran; Middle Aged; Pain Management; Pain Measurement; Pain, Postoperative; Postoperative Nausea and Vomiting; Pregabalin; Prospective Studies; Treatment Outcome

To determine the efficacy of 2 different doses (150-300mg) of preoperative pregabalin on propofol and remifentanil doses for total intravenous anesthesia in laparoscopic cholecystectomy.. Prospective, randomized, placebo-controlled, double-blinded study.. Training and research hospital.. Forty-eight adult, American Society of Anesthesiologists physical status 1 and 2 patients.. Patients were randomly assigned to 3 groups to receive orally 1hour before surgery, a placebo group (group 1), pregabalin 150mg (group 2), or pregabalin 300mg (group 3).. In the operating room, heart rate, systolic and diastolic blood pressures, SpO. The remifentanil doses used in the pregabalin groups at minutes 10, 15, 20, 25, and 30 and propofol doses at minutes 15, 20, 25, and 30 were statistically significantly lower in comparison to the placebo group.. The observations provide preliminary evidence that preoperative pregabalin may decrease anesthetic agent requirement in total intravenous anesthesia patients.

Topics: Administration, Oral; Adult; Anesthesia, General; Anesthesia, Intravenous; Anesthetics, Intravenous; Cholecystectomy, Laparoscopic; Double-Blind Method; Female; Humans; Hypnotics and Sedatives; Male; Middle Aged; Pain, Postoperative; Piperidines; Placebos; Pregabalin; Preoperative Care; Propofol; Prospective Studies; Remifentanil; Treatment Outcome

Management of postoperative pain is a common problem in endoscopic sinus surgery. The objective of this study is the evaluation of pregabalin and acetaminophen effects on the management of postoperative pain in patients with nasal polyposis undergoing functional endoscopic sinus surgery (FESS).. In this clinical trial, double-blinded study, 70 patients with nasal polyposis who have indication of FESS were enrolled to this study. After operation, patients were divided randomly into pregabalin and acetaminophen therapy groups. The pregabalin group (n = 35) was treated under pregabalin 50 mg TDS and the acetaminophen group (n = 35) was treated under tablet acetaminophen 500 mg/6 h. Each group was administered for 3 d. The visual analogue scale (VAS) was measured in onset, 12, 24, 48 and 72 h after surgery. All data were entered into SPSS software (SPSS Inc., Chicago, IL) and appropriate statistical tests were assessed to every relation.. In this study, there was no significant difference between two groups according to VAS in onset (p = .37); however, VAS in 12, 24, 48 and 72 h after operation was significantly lower in the pregabalin group compared with the acetaminophen group (p < .0001, for every four). Also in the pregabalin group, adverse effects were significantly lower than the acetaminophen group (p < .03).. Pregabalin has more effect, safely and usefully than acetaminophen on the management of postoperative pain in the patients with nasal polyposis undergoing functional endoscopic sinus surgery.

Topics: Acetaminophen; Adult; Analgesics; Double-Blind Method; Female; Humans; Male; Middle Aged; Nasal Polyps; Natural Orifice Endoscopic Surgery; Otorhinolaryngologic Surgical Procedures; Pain, Postoperative; Pregabalin

Gabapentinoids are increasingly used to reduce acute postoperative pain, opioid consumption and opioid-related adverse effects. We explored the opioid-sparing, analgesic and anti-hyperalgesic effect of perioperative administered pregabalin in laparoscopic living donor nephrectomy.. In this randomized controlled trial, 80 patients were recruited and randomized to receive pregabalin 150 mg twice daily or placebo on the day of surgery and the first postoperative day as part of a multimodal analgesic regimen. Primary outcome was opioid consumption 0-48 h after surgery. Secondary outcomes were pain intensity at rest and with movement 0-48 h after surgery using the 0-10 Numeric Rating Scale and incisional hyperalgesia measured 24 h post-surgery and at hospital discharge. Further secondary outcomes were adverse effects. Persistent post-surgical pain was registered 6 weeks, 6 and 12 months after surgery.. Pregabalin significantly reduced opioid consumption compared with placebo 0-48 h after surgery (median mg [25th, 75th percentile]); 29.0 (22.0-45.5) vs. 41.8 (25.8-63.6) (P = 0.04). Pain intensity 0-48 h after surgery calculated as area under the pain (NRS) vs. time curve was not statistically different between groups at rest (P = 0.12) or with movement (P = 0.21). Pregabalin decreased incisional hyperalgesia 24 h after surgery (median cm [25th, 75th percentile] 8.5 (1.0-18.5) vs. 15.5 (9.5-24.0) (P = 0.02). Nausea (P ≤ 0.01), use of antiemetics (P ≤ 0.01) and pain-related sleep interference (P = 0.02) were reduced with pregabalin.. Perioperative pregabalin added to a multimodal analgesic regimen was opioid-sparing, but made no difference to pain intensity score 0-48 h after surgery. Pregabalin may reduce incisional hyperalgesia on the first day after surgery.

Topics: Adult; Analgesics; Analgesics, Opioid; Female; Humans; Hyperalgesia; Laparoscopy; Male; Middle Aged; Nephrectomy; Pain Measurement; Pain, Postoperative; Pregabalin

To determine if preoperative pregabalin could decrease 24-h postoperative morphine consumption after spinal anesthesia with intrathecal morphine compared with placebo.. A randomized, double-blind, controlled trial was performed in the tertiary care center. Patients aged between 18 and 65 years who were American Society of Anesthesiologists class I-II and scheduled for abdominal hysterectomy with or without salpingo-oophorectomy were randomly allocated to a placebo or a pregabalin group. Patients received pregabalin 150 mg or placebo 1 h prior to anesthesia. Spinal anesthesia was achieved with 0.5% hyperbaric bupivacaine with morphine 0.2 mg. Intravenous patient-controlled analgesia morphine was provided postoperatively. Postoperative morphine consumption at 6, 12, and 24 h, time to first analgesic rescue, pain scores, adverse effects, and patient satisfaction were evaluated at 24 h after the operation.. One hundred twenty-five patients were recruited and 119 patients (placebo N = 58, pregabalin N = 61) were included in the analysis. Forty-seven (81.0%) patients in the placebo group and 53 (86.9%) patients in the pregabalin group required morphine in the first 24 h. Median [IQR] 24-h morphine consumption was 4.0 [1.8, 10.0] mg in the placebo group and 5.0 [2.0, 11.0] mg in the prebagalin group, p = 0.60. There were no differences in cumulative morphine consumption at 6, 12, and 24 h postoperatively. The two groups also did not differ in time to first analgesic rescue, pain scores at rest and on movement, and side effects.. A single preoperative dose of pregabalin 150 mg did not reduce 24-h postoperative morphine consumption or pain scores or prolong the time to first analgesic rescue in spinal anesthesia with intrathecal morphine.

Topics: Adolescent; Adult; Aged; Analgesia, Patient-Controlled; Analgesics; Anesthesia, Spinal; Bupivacaine; Double-Blind Method; Female; Humans; Hysterectomy; Male; Middle Aged; Morphine; Ovariectomy; Pain, Postoperative; Pregabalin; Young Adult

Ibuprofen and pregabalin both have independent positive effects on postoperative pain. The aim of the study is researching effect of 800 mg i.v. ibuprofen in addition to preoperative single dose pregabalin on postoperative analgesia and morphine consumption in posterior lumbar interbody fusion surgery.. 42 adult ASA I-II physical status patients received 150 mg oral pregabalin 1 hour before surgery. Patients received either 250 ml saline with 800 mg i.v. ibuprofen or saline without ibuprofen 30 minutes prior to the surgery. Postoperative analgesia was obtained by morphine patient controlled analgesia (PCA) and 1 g i.v. paracetamol every six hours. PCA morphine consumption was recorded and postoperative pain was evaluated by Visual Analog Scale (VAS) in postoperative recovery room, at the 1st, 2nd, 4th, 8th, 12th, 24th, 36th, and 48th hours.. Postoperative pain was significantly lower in ibuprofen group in recovery room, at the 1st, 2nd, 36th, and 48th hours. Total morphine consumption was lower in ibuprofen group at the 2nd, 4th, 8th, 12th, and 48th hours.. Multimodal analgesia with preoperative ibuprofen added to preoperative pregabalin safely decreases postoperative pain and total morphine consumption in patients having posterior lumbar interbody fusion surgery, without increasing incidences of bleeding or other side effects.

Topics: Acetaminophen; Administration, Intravenous; Adult; Aged; Analgesia, Patient-Controlled; Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Female; Humans; Ibuprofen; Lumbosacral Region; Male; Middle Aged; Morphine; Pain Management; Pain Measurement; Pain, Postoperative; Pregabalin; Spinal Fusion; Time Factors

Depending on the type of injury, the pain mechanisms are multifactorial. Preoperative pregabalin administrations as an adjunct to a multimodal postoperative pain management strategy have been tested in various surgical settings. The purpose of current study was to evaluate the effects of preoperative pregabalin administration on postoperative pain intensity and rescue analgesic requirement following video-assisted thoracoscopic surgery (VATS).. Sixty adult patients undergoing VATS were randomly assigned either to receive pregabalin 150 mg (Pregabalin group) or placebo (Control group) 1 hour before anesthesia. Primary efficacy variable was pain intensity. Secondary efficacy variables were the requirement of rescue analgesics, total volume of intravenous patient-controlled analgesia (IV-PCA), and adverse effects induced by pregabalin or IV-PCA.. Pain intensity scores at post-anesthesia care unit (PACU), 6 and 24 hours were lower significantly in the Pregabalin group compared with the Control group (mean [SD]; 5.6 [2.0] vs 6.8 [1.8]; mean difference: 1.2, 95% CI of difference: 0.2166-2.1835, P = .018, mean [SD]; 3.8 [1.9] vs 5.6 [1.4]; mean difference: 1.8, 95% CI of difference: 1.0074-2.7260, P = .001 and mean [SD]; 2.6 [1.6] vs 3.5 [1.5]; mean difference: 0.9, 95% CI of difference: 0.0946-1.7054, P = .029, respectively]. Also, the frequency of additional rescue drug administered at PACU (median [interquartile range]; 2 [2-3] vs 1 [1-2], P = .027) was significantly less in the Pregabalin group. The incidences of adverse effects related to pregabalin or IV-PCA were not different between the groups.. A single administration of pregabalin 150 mg before VATS decreased postoperative pain scores and incidence of additional rescue analgesics in the immediate postoperative period without increased risk of adverse effects.

Topics: Aged; Analgesia, Patient-Controlled; Analgesics; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Pain Management; Pain, Postoperative; Pregabalin; Premedication; Thoracic Surgery, Video-Assisted; Treatment Outcome

Chronic postthoracotomy pain (CPTP) consists of different types of pain. Some characteristics of CPTP are the same as those of recognized neuropathic pain syndromes. We aimed to determine the safety and efficacy of pregabalin and methylcobalamin combination (PG-B. One hundred consecutive patients with CPTP after posterolateral/lateral thoracotomy were prospectively randomly assigned and evaluated. Fifty patients were given PG-B. The mean ages were 58.7 ± 12.2 and 54.6 ± 14.5 years, and the mean durations of pain were 4.01 ± 1.04 and 3.8 ± 1.02 months, respectively. The number of patients with a VAS score less than 5 at the latest follow-up (VAS90 < 5) was 44 (88%) and 18 (36%) in the PG-B. PB-B

Topics: Adult; Aged; Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Chronic Pain; Diclofenac; Drug Combinations; Female; Humans; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Pregabalin; Thoracotomy; Vitamin B 12

Use of pregabalin is increasing in cardiac surgical patients. However, studies using comprehensive scoring systems are lacking on the drug's impact on postoperative recovery. The authors tested the hypothesis that perioperative oral pregabalin improves the postoperative quality of recovery as assessed using the Quality of Recovery (QoR-40) questionnaire in patients undergoing off-pump coronary artery bypass grafting (OPCABG).. This was a randomized, double-blind, placebo-controlled study.. Tertiary-care hospital.. Patients undergoing OPCABG.. Patients were assigned randomly to the following 2 groups: the pregabalin group (those who received pregabalin, 150 mg capsule orally, 1 hour before surgery and 2 days postoperatively [75 mg twice a day] starting after extubation; n = 37); and the control group (those who received 2 similar-looking multivitamin capsules at similar times; n = 34). The QoR-40 scores were noted preoperatively and 24 hours after extubation.. Both groups were comparable in terms of preoperative patient characteristics and baseline QoR-40 scores. Global scores were significantly improved in the pregabalin group compared with the control group in the postoperative period (177±9 v 170±9; p = 0.002). QoR-40 values in the dimensions of emotional state (p = 0.005), physical comfort (p = 0.04), and pain (p = 0.02) were improved in the pregabalin group.. Perioperative pregabalin improved postoperative quality of recovery as assessed using the QoR-40 questionnaire in patients undergoing OPCABG. Perioperative pregabalin offered advantages beyond better pain control, such as improved physical comfort and better emotional state; therefore, the drug's use in the perioperative period is recommended.

Topics: Aged; Analgesics; Coronary Artery Bypass; Double-Blind Method; Female; Humans; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Perioperative Care; Postoperative Care; Pregabalin; Prospective Studies; Recovery of Function; Treatment Outcome

To assess the efficacy of a novel preemptive multimodal analgesic regimen for reducing postoperative pain and complications after primary lumbar fusion surgery. Preemptive multimodal analgesia is revealed to be an effective alternative to conventional morphine administration providing improved postoperative pain control with diminished side effects. However, an optimal regimen for spinal fusion surgery remains unknown.. After Institutional Review Board approval, 80 patients who underwent primary lumbar 4-5 fusion surgery were randomly assigned to receive either only intravenous morphine or a preemptive multimodal (celecoxib, pregabalin, extended-release oxycodone, and acetaminophen) analgesic regimen. Postoperative pain and functional levels were measured by the visual analog scale (VAS) and Oswestry Disability Index (ODI), respectively, and intraoperative blood loss, postoperative Hemovac drain output, and nonunion rates were evaluated for complications.. No differences were observed in the patient demographics, intraoperative blood loss, postoperative Hemovac drain output, or nonunion rate between two groups. The VAS and ODI were lower at all postoperative time points, except the ODI on postoperative day 1 in patients randomized to receive the preemptive multimodal analgesic regimen. No major identifiable postoperative complications were observed in either treatment group.. The preemptive multimodal analgesic combination in this study appears to be safe and effective after lumbar fusion surgery.

Topics: Acetaminophen; Aged; Analgesics; Analgesics, Opioid; Celecoxib; Delayed-Action Preparations; Drug Therapy, Combination; Female; Humans; Lumbar Vertebrae; Male; Morphine; Pain, Postoperative; Pregabalin; Prospective Studies; Spinal Fusion; Visual Analog Scale

Early postoperative pain is a common complaint after elective laparoscopic cholecystectomy. The use of non-opioid medications as a part of multimodal analgesia has been increasingly advocated in the management of acute post-surgical pain. This randomized, double-blinded, placebo-controlled study evaluated the efficacy of pregabalin, celecoxib, and their combination in the management of acute postoperative pain in patients undergoing elective laparoscopic cholecystectomy.. One hundred ASA I/II patients scheduled to undergo elective laparoscopic cholecystectomy were assigned to receive two perioperative doses, 12 h apart, of either pregabalin alone, celecoxib alone, their combination, or a placebo. Standard anesthetic protocol was followed. The primary outcomes were postoperative pain at rest and with movement. Secondary outcomes were fentanyl requirements and side effects, which were assessed at 1, 2, 4, 8, 12, and 24 h following surgery. Patient satisfaction with pain relief was recorded at discharge. Differences in main outcomes were analyzed using an intention-to-treat approach.. There was no statistically significant difference (p > 0.05) between the four groups in terms of outcomes such as rest pain, movement pain, postoperative fentanyl requirements, or changes in anxiety scores. Patients who had only celecoxib had significantly higher satisfaction with pain management (p = 0.013). Patients who had only pregabalin were at three-times-higher odds of having drowsiness (p = 0.040) and four-times-higher odds of having lightheadedness (p = 0.019) when compared with the placebo group.. Pregabalin, celecoxib alone, or in combination offers no analgesic superiority over standard opioid care in the treatment of postoperative pain following laparoscopic cholecystectomy.

Topics: Adult; Aged; Analgesics; Analgesics, Opioid; Celecoxib; Cholecystectomy, Laparoscopic; Double-Blind Method; Elective Surgical Procedures; Female; Fentanyl; Humans; Male; Middle Aged; Pain, Postoperative; Patient Satisfaction; Pregabalin; Prospective Studies

The effect of a single-dose of pre-emptive pregabalin is still unknown, although it is used as an adjuvant in controlling acute postoperative pain. The purpose of this study was to evaluate the effects of pre-emptive single-dose pregabalin on postoperative acute pain and 24-hour opioid consumption in patients who underwent double-jaw surgery.. Forty patients (18 to 45 yr old; American Society of Anesthesiologists status I to II) for whom elective double-jaw surgery was planned under general anesthesia were included in this study, which had been planned as a prospective, randomized, and double-blinded study. Patients were randomly divided into 2 groups: the pregabalin group (n = 20) was given pregabalin 150 mg orally 1 hour before general anesthesia and the placebo group (n = 20) was given an oral placebo capsule. The groups were administered the routine general anesthesia protocol. Postoperative analgesia was performed intravenously in the 2 groups twice a day with dexketoprofen trometamol 50 mg and patient-controlled analgesia with fentanyl. Postoperative analgesia was evaluated using the visual analog scale (VAS). Fentanyl consumption, additional analgesia requirement, and side-effects were recorded during the first 24 hours after surgery. Descriptive and bivariate statistics were computed, and significance was set at a P value less than .05.. Compared with placebo, the VAS score was statistically lower in the pregabalin group during the early postoperative period (P < .05). The 24-hour opioid consumption was significantly higher in the placebo group compared with the pregabalin group (509.40 ± 261.56 vs. 260.10 ± 246.53 μq, respectively; P = .004). In addition, the analgesia requirement was statistically lower in the pregabalin group (P < .05). Nausea or vomiting was observed more often in the placebo group, whereas other side-effects were similar for the 2 groups.. A single 150-mg dose of pre-emptive pregabalin decreased postoperative opioid consumption in the first 24 hours after double-jaw surgery. Multimodal analgesia techniques that contain pre-emptive analgesia can be used successfully in preventing postoperative pain caused by orthognathic surgery.

Topics: Adolescent; Adult; Analgesia, Patient-Controlled; Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Double-Blind Method; Female; Fentanyl; Follow-Up Studies; Humans; Ketoprofen; Male; Middle Aged; Narcotics; Orthognathic Surgical Procedures; Osteotomy, Le Fort; Osteotomy, Sagittal Split Ramus; Pain Measurement; Pain, Postoperative; Placebos; Postoperative Nausea and Vomiting; Pregabalin; Premedication; Prospective Studies; Tromethamine; Young Adult

The purpose of the current study was to evaluate the effects of pregabalin administration as an adjunct to fentanyl-based intravenous patient-controlled analgesia on opioid consumption and postoperative pain following arthroscopic shoulder surgery.. In this randomized controlled trial, 60 adult patients undergoing arthroscopic shoulder surgery were randomly assigned to receive either pregabalin 150 mg (Pregabalin group, n = 30) or placebo (Control group, n = 30) one hour before anesthetic induction. The primary outcome was the cumulative amount of fentanyl consumption during 48 hr postoperatively. Secondary outcomes were pain intensity, the number of rescue analgesics administered, and adverse effects related to the analgesic regimen, which were serially assessed during 48 hr postoperatively.. The cumulative fentanyl consumption during 48 hr postoperatively was significantly lower in the Pregabalin group than in the Control group ([1,126.0 (283.6) μg vs 1,641.4 (320.3) μg, respectively; mean difference, 515.4 μg; 95% confidence interval [CI], 359.0 to 671.8; P = < 0.001). Numeric rating scores for pain (0 to 10) were significantly lower in the Pregabalin group at six hours (mean difference, 2.9; 95% CI, 1.8 to 4.0), 24 hr (mean difference, 2.9; 95% CI, 1.9 to 3.8), and 48 hr (mean difference, 1.5; 95% CI, 0.6 to 2.3). The incidence of adverse effects related to the analgesic regimens, including nausea, sedation, and dizziness, were similar between the two groups.. A preoperative dose of pregabalin 150 mg administered before arthroscopic shoulder surgery resulted in significant analgesic efficacy for 48 hr in terms of opioid-sparing effect and improved pain intensity scores without influencing complications. This trial was registered at: http://cris.nih.go.kr , number CT0000578.

Topics: Adult; Aged; Analgesia, Patient-Controlled; Analgesics; Arthroscopy; Female; Fentanyl; Humans; Male; Middle Aged; Pain, Postoperative; Pregabalin; Prospective Studies; Shoulder

We allocated 52 participants to oral pregabalin 300 mg and 48 participants to placebo tablets before thoracoscopic surgery and for five postoperative days. The median (IQR [range]) cumulative pain scores at rest for nine postoperative months were 184 (94-274 [51-1454]) after pregabalin and 166 (66-266 [48-1628]) after placebo, p = 0.39. The corresponding scores on deep breathing were 468 (281-655 [87-2870]) and 347 (133-561 [52-3666]), respectively, p = 0.16. After three postoperative months, 29/100 participants had persistent surgical site pain, 19/52 after pregabalin and 10/48 after placebo, p = 0.12, of whom four and five, respectively, attended a pain management clinic, p = 0.24. The median (IQR [range]) morphine equivalent consumption six days after surgery was 273 (128-619 [39-2243]) mg after pregabalin and 319 (190-663 [47-2258]) mg after placebo, p = 0.35.

Topics: Analgesics; Analgesics, Opioid; Female; Follow-Up Studies; Humans; Male; Middle Aged; Morphine; Pain, Postoperative; Placebos; Postoperative Care; Pregabalin; Preoperative Care; Quality of Life; Thoracic Surgery, Video-Assisted

The aim of this randomized controlled clinical trial was to evaluate the efficacy and safety of pregabalin administered pre- and postoperatively in patients with pain and swelling due to the surgical removal of impacted lower third molars.. The final study sample comprised 60 volunteers (23 males and 37 females). Group 1 (n = 30) received 75 mg oral pregabalin 1 h before surgery and 1 h after surgery. Group 2 (n = 30) served as a control group and received no pregabalin. Both groups were administered with 650 mg paracetamol every 8 h for 2 days. Postoperative pain intensity and swelling were measured using a visual analog scale (VAS); pain relief experienced was reported using a four-point verbal rating scale (VRS); the rescue medication requirement, adverse effects, and global impression of the medication were also recorded.. No significant difference in pain intensity (VAS) was observed between the groups. However, fewer rescue medication tablets were needed by pregabalin-treated patients than by controls (p = 0.021). The frequency and intensity of adverse effects were significantly higher in pregabalin-treated patients (p < 0.001), although no serious adverse events occurred. No significant difference in the degree of swelling was observed in any measurement except that from mandibular angle to lip junction, which showed lesser inflammation in the pregabalin group at 24 h post-surgery (p = 0.011). The global opinion on the medication received was more positive in the pregabalin group (p = 0.042).. The administration of pregabalin reduces the requirement for rescue medication after third molar surgery and results in a more constant pain level, with fewer peaks of pain intensity.. These findings suggest that pregabalin may be useful to control acute postoperative pain. Adverse effects are known to be reduced at the low pregabalin dose used in our study.

Topics: Administration, Oral; Adolescent; Adult; Analgesics; Female; Humans; Male; Molar, Third; Pain Measurement; Pain, Postoperative; Pregabalin; Tooth Extraction; Tooth, Impacted

We hypothesised that preoperative administration of a single-dose of pregabalin would be associated with lower morphine consumption after uncomplicated caesarean delivery.. After Institutional Ethics Committee approval, 135 parturients scheduled for elective caesarean delivery under spinal anaesthesia were randomly allocated to receive either placebo, or oral pregabalin 150mg or 300mg, one hour before induction of anaesthesia. Maternal cumulative morphine requirement at 24h, pain scores, sedation scores, nausea and vomiting, pruritus, pregabalin-related adverse effects, Apgar scores, Neurologic and Adaptive Capacity scores and umbilical cord acid-base status were recorded.. Compared with placebo or pregabalin 150mg, the use of a preoperative dose of pregabalin 300mg resulted in significantly lower cumulative morphine consumption at 24h (mean dose: placebo 12.9mg [95% CI 11.6 to 14.2]; pregabalin 150mg 11.9mg; [95% CI 10.7 to 13.1]; pregabalin 300mg 6mg [95% CI 5.4 to 7.3]; P<0.001). Pregabalin 300mg resulted in lower pain scores at 4h and 6h after delivery (P<0.001), and fewer instances of nausea, vomiting and pruritus (P<0.009). Dizziness and abnormal vision were observed most frequently in the pregabalin 300mg group (P<0.05 and P<0.009, respectively). The three groups were similar in terms of maternal sedation, Apgar scores, Neurologic and Adaptive Capacity scores and umbilical cord acid-base status. Three babies in the pregabalin 300mg group (6.7%) experienced short-term poor latching-on for breastfeeding.. In our study, preoperative administration of pregabalin 300mg reduced postoperative morphine consumption and early postoperative pain in parturients undergoing elective caesarean delivery, although maternal side effects were more common.

Topics: Adolescent; Adult; Analgesics; Apgar Score; Cesarean Section; Dose-Response Relationship, Drug; Female; Humans; Pain, Postoperative; Pregabalin; Pregnancy; Preoperative Period

OBJECTIVE The aim of this study was to assess in-hospital (immediate) postoperative pain scores and analgesic consumption (primary goals) and preoperative anxiety and sleep quality (secondary goals) in patients who underwent craniotomy and were treated with pregabalin (PGL). Whenever possible, out-of-hospital pain scores and analgesics usage data were obtained as well. METHODS This prospective, randomized, double-blind and controlled study was conducted in consenting patients who underwent elective craniotomy for brain tumor resection at Tel Aviv Medical Center between 2012 and 2014. Patients received either 150 mg PGL (n = 50) or 500 mg starch (placebo; n = 50) on the evening before surgery, 1.5 hours before surgery, and twice daily for 72 hours following surgery. All patients spent the night before surgery in the hospital, and no other premedication was administered. Opioids and nonsteroidal antiinflammatory drugs were used for pain, which was self-rated by means of a numerical rating scale (score range 0-10). RESULTS Eighty-eight patients completed the study. Data on the American Society of Anesthesiologists class, age, body weight, duration of surgery, and intraoperative drugs were similar for both groups. The pain scores during postoperative Days 0 to 2 were significantly lower in the PGL group than in the placebo group (p < 0.01). Analgesic consumption was also lower in the PGL group, both immediately and 1 month after surgery. There were fewer requests for antiemetics in the PGL group, and the rate of postoperative nausea and vomiting was lower. The preoperative anxiety level and the quality of sleep were significantly better in the PGL group (p < 0.01). There were no PGL-associated major adverse events. CONCLUSIONS Perioperative use of twice-daily 150 mg pregabalin attenuates preoperative anxiety, improves sleep quality, and reduces postoperative pain scores and analgesic usage without increasing the rate of adverse effects. Clinical trial registration no.: NCT01612832 ( clinicaltrials.gov ).

Topics: Analgesics; Anxiety; Craniotomy; Double-Blind Method; Drug Utilization; Elective Surgical Procedures; Female; Humans; Male; Middle Aged; Neurosurgical Procedures; Pain Measurement; Pain, Postoperative; Perioperative Care; Pregabalin; Prospective Studies; Quality of Life; Sleep; Time Factors

Adjuvant agents, given with local anesthetics or via venous, oral, or rectal routes for peripheral nerve blocking, have been in use for a long time. Literature studies about pregabalin usage in peripheral nerve blocking are limited in number. In this study, we aimed to reveal the blocking quality of pregabalin administered orally in various doses as an anxiolytic agent and its effective dose range.. Eighty patients who underwent upper extremity bone surgery were included in the study. The cases were divided into 4 randomized groups of 20 patients. The group that did not receive any medication before the surgery was named the Control Group (Group C), the group that received 75 mg pregabalin per os was named Group P75, the group that received 150 mg pregabalin per os was named Group P150, and the group that received 300 mg pregabalin per os was named Group P300. The study had a controlled and double-blind design. Before, during and after routine peripheral nerve blocking, vital signs, Ramsey Sedation Scale, Patient Satisfaction, Visual Analog Scale, and termination durations of sensorial and motor blocks were recorded.. Motor block initiation durations of all groups given pregabalin were significantly shorter than those of Group C. Sensorial block termination durations were similar in Group P150 and Group P300, and both were significantly longer than those in Group C and Group P75. First analgesic requirement time for Group P150 and Group P300 were significantly longer than that of Group P75. Although there was no significant difference between postoperative patient satisfaction and VAS values, first analgesic requirement times of the pregabalin administered groups were longer than those of the control group.. The patients, who are about to undergo surgery, generally develop anxiety about death, not waking up from anesthesia, disability, pain and loss of ability to work. Pregabalin is an anti-epileptic, analgesic and anxiolytic agent. With these characteristics, it can be used to reduce pre-operative anxiety, for prophylaxis against convulsions and post-operative analgesia. One hundred fifty mg of pregabalin provides sufficient and effective analgesia, and this dose positively affects the quality of the block.

Topics: Adolescent; Adult; Anesthetics, Local; Anti-Anxiety Agents; Anxiety; Dose-Response Relationship, Drug; Double-Blind Method; Female; Humans; Male; Middle Aged; Nerve Block; Pain Measurement; Pain, Postoperative; Pregabalin; Ultrasonography, Interventional; Young Adult

Topics: Adolescent; Adult; Aged; Analgesics; Analgesics, Opioid; Chronic Pain; Female; Fentanyl; Hernia, Inguinal; Herniorrhaphy; Humans; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Pregabalin; Surgical Mesh; Treatment Outcome; Young Adult

To determine whether single preoperative administration of 2 different doses of pregabalin (75 and 150 mg) could decrease postoperative pain intensity and opioid consumption following posterior lumbar interbody fusion surgery.. Prospective, randomized, active placebo-controlled, double-blinded study.. Postoperative recovery area and patients' room.. Ninety-seven adult, American Society of Anesthesiologists physical status 1 and 2 patients.. Patients were randomly assigned to receive diazepam 5 mg as an active placebo (D5), pregabalin 75 mg (P75), or pregabalin 150 mg (P150). The study drug was orally administered 2 hours prior to surgery and a standard anesthetic technique was used. Postoperative pain was managed using intravenous patient-controlled analgesia with morphine.. The visual analog scale at rest was used to measure pain intensity immediately after extubation at the postanesthesia care unit, and then 2, 4, 6, 12, 18, 24, 36, and 48 hours after surgery. Morphine consumption and adverse effects were assessed until 48 hours after surgery.. The visual analog scale score at rest was lower in the P150 group than in the D5 group until 2 hours after surgery. Morphine consumption was lower in the P150 group than in the D5 from 0 to 12 hours after surgery.. Single preoperative administration of 150 mg of pregabalin 2 hours prior to surgery reduced postoperative pain intensity and morphine consumption compared with 5 mg diazepam in patients who underwent posterior lumbar interbody fusion.

Topics: Aged; Analgesics; Dose-Response Relationship, Drug; Double-Blind Method; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Pain, Postoperative; Pregabalin; Preoperative Care; Prospective Studies

The administration of oral pregabalin preoperatively has been reported to reduce acute postoperative pain. However, no clinical study to date has yet fully investigated whether or not pregabalin premedication affects sensory and motor blocks using spinal anesthesia and its effect upon early postoperative pain management. This prospective, randomized, and double-blind clinical study was designed to evaluate the efficacy of a single dose of pregabalin in terms of spinal blockade duration and its potential opioid-sparing effect during the first 24 hours subsequent to urogenital surgery.. Forty-four patients scheduled for urogenital surgery under spinal anesthesia were randomly allocated to 2 groups: group C (no premedication; orally administered placebo 2 hours before surgery) and group P (orally administered 150 mg pregabalin 2 hours before surgery).. The duration of sensory and motor blockade was significantly prolonged in group P patients when compared with that in group C patients, and the pain scores at postoperative 6 and 24 hours were significantly lower in group P patients. Requests for analgesics during the first postoperative 24 hours were lower among group P patients.. Premedication with a single dose of 150 mg pregabalin before surgery promoted the efficacy of intrathecal bupivacaine and improved postoperative analgesia in patients undergoing urogenital surgery under spinal anesthesia.

Topics: Administration, Oral; Adult; Aged; Analgesics; Anesthesia, Spinal; Anesthetics, Local; Bupivacaine; Double-Blind Method; Female; Humans; Male; Middle Aged; Pain, Postoperative; Pregabalin; Preoperative Care; Prospective Studies; Time Factors; Urogenital Surgical Procedures

We hypothesized that oral administration of a single dose of pregabalin 2 hours before modified radical mastectomy (MRM) would produce dose-related reduction in postoperative opioid consumption.. Prospective randomized controlled clinical trial.. Postanesthesia care unit.. One hundred twenty adult women scheduled for unilateral (MRM) with axillary evacuation.. Patients were randomized to receive either, placebo capsule, pregabalin 75 mg, pregabalin 150 mg, or pregabalin 300 mg.. The assessment parameters were the postoperative analgesic effect using visual analog scale (VAS) pain scores, the subsequent 24-hour morphine consumption, and the systemic adverse effects of pregabalin doses.. The VAS score at rest and movement was significantly decreased only in group P300 and group P150 in comparison to group P0 and group P75 at 0 hour (P<.01). The median (interquartile range) consumption of morphine in the first postoperative 24 hours was significantly decreased in group P300 in comparison to group P0 and group P75 (P300 vs P0: 6.5 [5-6.5] vs 20.5 [15.8-20.5] [P<.001]; P300 vs P75: 6.5 [5-6.5] vs 20 [14-20] [P<.001]), but there was no significant difference between group P300 and group P150. In addition, there was a significant decrease in consumption of morphine in group P150 in comparison to group P0 and group P75 (P150 vs P0: 7 [5-7] vs 20.5 [15.8-20.5] [P<.001]; P150 vs P75: 7 [5-7] vs 20 [14-20] [P<.001]). There were statistical significant increase in dizziness and blurred vision in group P300 in comparison to other groups (P<.05).. A single preoperative oral dose of pregabalin 150 mg is an optimal dose for reducing postoperative pain and morphine consumption in patients undergoing MRM.

Topics: Adult; Analgesics; Analgesics, Opioid; Dose-Response Relationship, Drug; Double-Blind Method; Female; Humans; Mastectomy, Modified Radical; Middle Aged; Morphine; Pain Measurement; Pain, Postoperative; Pregabalin; Prospective Studies; Time Factors

Despite the progress in understanding acute pain physiology during recent decade, eighty percent of patients still suffer from post-operative discomfort. Pregabalin is an anticonvulsant agent that is approved for painful neuropathies in diabetic patients and post herpetic neuralgia. The main objective of the present study was to compare the improvement in post-operative pain management and patient lifestyle in 3 groups, as first group received placebo, second who received Pregabalin for one day and the last group those who received it for 14 days.. This was a prospective single center, randomized, triple-blind, 3-arm, parallel group study. In this triple-blind study, patients were randomized to 1 of 3 groups using computer-generated random number table. 1) The first group received placebo for 14 days, the second group received Pregabalin 300mg 8h preoperatively and 150mg 12 and 24h postoperatively and for the rest of 13days received placebo and the third group received Pregabalin 300mg eight hours preoperatively and 15mg every 12h postoperatively for 14 days. Name, age, gender, height, weight, education, duration of pain, past medical history, drug history,total morphine requirement at the time of discharge and MRI findings of all the patients were recorded, also they Numerical scale system (NRS) and Oswestry low back pain disability index (ODI) questionnaire were completed for them. All the patients were operated based on standard surgery techniques, bilateral foramenotomy and interlaminar discectomy.. Of the 105 patients who entered the run-in period, 47 patients (44.8%) were female and 58 (55.2%) were male. The Patients radicular pain mean score based on NRS estimated before surgery was 7.22±1.95 in pregabalin14, 7.71±1.84 in pregabalin1 and 7.45±1.9 in control group. There were no statically significant differences between three groups (P-Value>0.05). The Patients back pain mean score based on NRS was 5.2±2.87 in pregabalin14, 5.11±3.23 in pregabalin1 and 6.4±3.06 in control group. This means that there were no significant differences in the overall score among those three groups (P-Value>0.05). In comparison to their preoperative pain, the average radicular pain in each group of patients improved significantly 4, 8, 12 and 24h after the operation (P-Value<0.001), but there were no significant differences in radicular pain improvements comparing three groups.. The results of this study indicate that 1day and 2 weeks post-operative 300mg pregabalin administration may not improve acute pain, morphine consumption and quality of life of patients after surgery. It seems that the diseases cause chronic pain that requires long-term treatment with higher doses.

Topics: Adolescent; Adult; Aged; Analgesics; Diskectomy; Double-Blind Method; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Outcome Assessment, Health Care; Pain, Postoperative; Pregabalin; Young Adult

We sought to compare a group (Group L) (n=21) of patients that underwent total knee arthroplasty and received a single preoperative dose of pregabalin combined with a COX-2 inhibitor with a control group (Group C) (n=20) that only received a COX-2 inhibitor in terms of (1) acute postoperative pain intensity, (2) analgesic consumption, and (3) functional recovery. Mean cumulative fentanyl consumption during the first 48 hours was lower in Group L than in Group C (P<0.05). The pain scores at rest were lower in Group L at 6 and 12 hours after surgery (P<0.05). No significant intergroup difference was noted in functional recovery. The addition of pregabalin led to an additive reduction in early postoperative pain and analgesic consumption.

Topics: Aged; Analgesics; Arthroplasty, Replacement, Knee; Cyclooxygenase 2 Inhibitors; gamma-Aminobutyric Acid; Humans; Middle Aged; Osteoarthritis, Knee; Pain, Postoperative; Pregabalin; Prospective Studies; Recovery of Function

The present study evaluated the efficacy of preoperative pregabalin for prevention of catheter-related bladder discomfort.. Prospective, randomized, placebo controlled, double blinded study.. Sixty patients of either sex undergoing elective spine surgery and requiring urinary bladder catheterization were randomly assigned to two groups. The patients in Group P (pregabalin group) received 150 mg of pregabalin orally 1 h prior to induction of anesthesia with sips of water and the patients in Group C (control group) received placebo. Anesthesia technique was identical in both the groups. Catheter-related bladder discomfort (CRBD) was evaluated on a 4-point scale (1 = no discomfort, 2 = mild, 3 = moderate, 4 = severe), on arrival (0 h) and again at 1, 2, and 6 h postoperatively. Patients were provided patient-controlled analgesia with fentanyl for postoperative pain relief.. The incidence of CRBD was significantly less in the pregabalin group compared with the control group at all time intervals (P < 0.05). The severity of CRBD was reduced in the pregabalin group compared with the control group at all time intervals except 6 h. The postoperative consumption of fentanyl was significantly less in group P, while the sedation score was significantly higher in the group P compared to group C.. Pretreatment with pregabalin 150 mg prevents CRBD and also decreases postoperative fentanyl consumption. ClinicalTrials.gov identifier: (ref: CTRI/2013/11/004170).

Topics: Adult; Analgesics; Analgesics, Opioid; Double-Blind Method; Female; Fentanyl; gamma-Aminobutyric Acid; Humans; Incidence; Male; Middle Aged; Pain, Postoperative; Pregabalin; Prospective Studies; Spine; Urinary Bladder Diseases; Urinary Catheterization; Urinary Catheters; Young Adult

A new perioperative management method was explored by assessing the safety and the efficacy of pregabalin for the treatment of intercostal neuralgia after thoracotomy.. The study was conducted on 68 adult patients scheduled to undergo thoracotomy. Patients were randomly divided into two groups; a NSAIDs group, where 34 patients were orally administered loxoprofen three times daily and a pregabalin group, where 34 patients were orally administered 75 mg of pregabalin twice daily, starting on the day of surgery and continuing for 2 weeks. The pain scores, sleep interference and the incidence of neuropathic pain were evaluated on days 1, 3 and 7, and at weeks 4, 8 and 12 after surgery. The frequency of pain medication use in the first week after surgery and the adverse effects in each group were also examined.. The pain scores, sleep interference and incidence of neuropathic pain were significantly lower (p < 0.001) at all time points in the pregabalin group. The use of additional pain medication during the first week after surgery was not significantly different between the groups. The only significant adverse effect was a stomach ache in the NSAIDs group, while mild drowsiness was reported in the pregabalin group.. Pregabalin is considered to be an effective and safe drug for the treatment of pain after thoracotomy.

Topics: Administration, Oral; Adult; Aged; Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Female; Humans; Male; Middle Aged; Neuralgia; Pain, Postoperative; Phenylpropionates; Pregabalin; Thoracotomy; Treatment Outcome

Although various analgesics have been used, postoperative pain remains one of the most troublesome aspects of tonsillectomy for patients.. The aim of the present study was to evaluate the effectiveness of premedication using pregabalin compared with placebo (diazepam) on postoperative pain control in patients undergoing tonsillectomy.. Forty-eight adult patients were randomly divided into a control group and a pregabalin group. Preoperatively, patients in the control group received 4 mg diazepam orally as placebo, whereas those in the pregabalin group received 300 mg pregabalin orally. All participants were provided with patient-controlled analgesia using fentanyl for 24 hours after surgery. Postoperative pain treatment included acetaminophen 650 mg three times daily for 8 postoperative days. The primary outcome measure was the total amount of patient-controlled fentanyl consumption after tonsillectomy. Secondary outcome measures were the number of injections of ketorolac tromethamine (each 30 mg) requested by patients, pain scores, overall satisfaction scores, drowsiness, nausea, dizziness, headache, and vomiting after the surgery. P < 0.05 was considered statistically significant.. The total amount of fentanyl demanded decreased significantly in the pregabalin group (P < 0.001). There were no significant differences in the number of ketorolac tromethamine injections, pain scores, overall satisfaction scores, drowsiness, nausea, dizziness, headache, and vomiting between the two groups.. Administration of 300 mg pregabalin prior to tonsillectomy decreases fentanyl consumption compared with that after 4 mg diazepam, without an increased incidence of adverse effects.. KCT0001215.

Topics: Adult; Analgesia, Patient-Controlled; Analgesics; Diazepam; Female; Humans; Male; Pain Measurement; Pain, Postoperative; Pregabalin; Premedication; Tonsillectomy; Treatment Outcome

This was a randomized, double-blinded clinical trial to study the effects of a single oral dose of pregabalin 150 mg in postoperative pain management after mastectomy.. forty nine patients ASA I or II, aged between 20-60 years, scheduled for mastectomy with or without axillary lymph nodes dissection (ALND) were recruited into this study. They were randomized into two groups, placebo (n = 24) or pregabalin (n = 25) receiving either oral pregabalin 150 mg or placebo when called to operation theatre (OT). The assessment of pain score were performed at recovery, 2, 4, 6 and 24 hours postoperatively at rest and on movement, using the verbal numeral rating score (VNRS).. VNRS scores for pain at rest were lower in the pregabalin group at 2 (p = 0.024), 4 (p = 0.006) and 6 (p = 0.003) hours postoperatively, and also at 4 (p = 0.005) and 6 (p = 0.016) hours postoperatively on movement compared to the placebo group. Incidences. of dizziness were common, however, side effects such as nausea and vomiting, headache, somnolence and visual disturbance were low and comparable in both groups.. A single dose of 150 mg pregabalin given preoperatively compared to placebo significantly reduced postoperative pain scores after mastectomy.

Topics: Administration, Oral; Adult; Analgesics; Double-Blind Method; Female; gamma-Aminobutyric Acid; Humans; Mastectomy; Middle Aged; Pain, Postoperative; Pregabalin

Pregabalin may reduce postoperative pain and opioid use. Higher doses may be more effective, but may cause sedation and confusion. This prospective, randomized, blinded, placebo-controlled study tested the hypothesis that pregabalin reduces pain at 2 weeks after total knee arthroplasty, but increases drowsiness and confusion.. Patients (30 per group) received capsules containing pregabalin (0, 50, 100, or 150 mg); two capsules before surgery, one capsule twice a day until postoperative day (POD) 14, one on POD15, and one on POD16. Multimodal analgesia included femoral nerve block, epidural analgesia, oxycodone-paracetamol, and meloxicam. The primary outcome was pain with flexion (POD14).. Pregabalin did not reduce pain at rest, with ambulation, or with flexion at 2 weeks (P=0.69, 0.23, and 0.90, respectively). Pregabalin increased POD1 drowsiness (34.5, 37.9, 55.2, and 58.6% in the 0, 50, 100, and 150 mg arms, respectively; P=0.030), but did not increase confusion (0, 3.5, 0, and 3.5%, respectively; P=0.75). Pregabalin had no effect on acute or chronic pain, opioid consumption, or analgesic side-effects. Pregabalin reduced POD14 patient satisfaction [1-10 scale, median (first quartile, third quartile): 9 (8, 10), 8 (7, 10), 8 (5, 9), and 8 (6, 9.3), respectively; P=0.023). Protocol compliance was 63% by POD14 (50.0, 70.0, 76.7, and 56.7% compliance, respectively), with no effect of dose on compliance. Per-protocol analysis of compliant patients showed no effect of pregabalin on pain scores.. Pregabalin had no beneficial effects, but increased sedation and decreased patient satisfaction. This study does not support routine perioperative pregabalin for total knee arthroplasty patients.. ClinicalTrials.gov: http://www.clinicaltrials.gov/ct2/show/study/NCT01333956.

Topics: Adult; Aged; Analgesics; Arthroplasty, Replacement, Knee; Dose-Response Relationship, Drug; Double-Blind Method; Female; gamma-Aminobutyric Acid; Humans; Male; Middle Aged; Pain, Postoperative; Pregabalin; Prospective Studies

The present study was performed to evaluate the effect of postoperative administration of pregabalin in patients who reported moderate-to-severe pain after epidural analgesia following thoracotomy.. An open-label, randomized, controlled, parallel-group study.. A single center in Japan.. Consecutive patients (aged≥20 years) who reported moderate-to-severe pain after effectual 2-day epidural analgesia post-thoracotomy for lung cancer from February 2012 to March 2013.. Patients were assigned to 2 groups: control (control treatment: acetaminophen, 400 mg, and codeine phosphate powder, 20 mg) or pregabalin (pregabalin, 75 mg, plus control treatment). The 12-week study period included 2-week study treatment and 10-week follow-up.. For efficacy, the primary endpoint was the visual analog scale (VAS) scores for pain at rest and with coughing at week 2, and secondary endpoints were the VAS scores for pain and the neuropathic pain questionnaire at week 12. Fifty patients were randomized (25 per group). At week 2, the VAS scores for pain at rest (mean [SD]) were 29.5 (21.9) in the control group and 16.3 (15) in the pregabalin group (p = 0.02); for pain with coughing, the scores were 45.2 (20.9) and 28.8 (25.9), respectively (p = 0.02). VAS scores improved more in the pregabalin group than in the control group over the 12 weeks. Patients free from possible neuropathic pain were 48% of the control group and 88% of the pregabalin group, respectively (p = 0.001).. Postoperative administration of pregabalin effectively reduced post-thoracotomy pain.

Topics: Aged; Double-Blind Method; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Postoperative Care; Pregabalin; Thoracotomy; Treatment Outcome

This study examined whether a perioperative regimen of pregabalin added to celecoxib improved pain scores and functional outcomes postdischarge up to 3 months after total hip arthroplasty (primary outcome) and acute postoperative pain and adverse effects (secondary outcomes).. One hundred and eighty-four patients were enrolled in a randomized, double-blind, placebo-controlled study. Two hours before receiving a spinal anaesthetic and undergoing surgery, patients received celecoxib 400 mg p.o. and were randomly assigned to receive either pregabalin 150 mg p.o. or placebo p.o. After surgery, patients received pregabalin 75 mg or placebo twice daily in hospital and for 7 days after discharge. Patients also received celecoxib 200 mg every 12 h for 72 h and morphine i.v. patient-controlled analgesia for 24 h. Pain and function were assessed at baseline, 6 weeks, and 3 months after surgery.. There was no difference between groups in physical function or incidence and intensity of chronic pain 3 months after total hip arthroplasty. The pregabalin group used less morphine [mean (sd): 39.85 (28.1) mg] than the placebo group [54.01 (31.2) mg] in the first 24 h after surgery (P<0.01). Pain scores were significantly lower in the pregabalin group vs the placebo group on days 1-7 after hospital discharge, and the pregabalin group required less adjunctive opioid medication (Percocet) 1 week after hospital discharge (P<0.05).. Perioperative administration of pregabalin did not improve pain or physical function at 6 weeks or 3 months after total hip arthroplasty. Perioperative administration of pregabalin decreased opioid consumption in hospital and reduced daily pain scores and adjunct opioid consumption for 1 week after discharge.

Topics: Aged; Analgesics, Non-Narcotic; Analgesics, Opioid; Anesthesia, Spinal; Arthroplasty, Replacement, Hip; Celecoxib; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Exercise Test; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Patient Discharge; Patient Selection; Perioperative Care; Postoperative Period; Pregabalin; Recovery of Function

Ketamine and pregabalin each provide postoperative analgesia, although the combination has yet to be evaluated. One hundred and forty-two patients undergoing total hip arthroplasty were randomly assigned to receive ketamine alone, pregabalin alone, ketamine and pregabalin combined, or placebo. Pain scores at rest and on movement, morphine consumption, side-effects, pressure pain thresholds and secondary hyperalgesia were evaluated. Mean (SD) total 48-h morphine use was reduced in patients given ketamine alone (52 (22) mg) and pregabalin alone (44 (20) mg) compared with placebo (77 (36) mg) p < 0.001. Morphine use was further reduced in patients given both ketamine and pregabalin (38 (19) mg) with an interaction between ketamine and pregabalin (ANOVA factorial; p = 0.028). Secondary hyperalgesia was reduced by ketamine. There were no differences between groups in pain scores after surgery, pressure pain thresholds or side-effects. The combination of pregabalin and ketamine has a small, beneficial clinical effect.

Topics: Administration, Oral; Adult; Aged; Analgesia, Patient-Controlled; Analgesics; Analgesics, Opioid; Arthroplasty, Replacement, Hip; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Female; gamma-Aminobutyric Acid; Humans; Infusions, Intravenous; Ketamine; Male; Middle Aged; Morphine; Movement; Pain Measurement; Pain, Postoperative; Perioperative Care; Pregabalin; Prospective Studies; Treatment Outcome

Prospective, double-blind study, randomized control trial.. To evaluate and compare the analgesic efficacy, adverse effects, and clinical utility of gabapentin and pregabalin in postoperative pain management, long-term functional outcome, and quality of life in patients undergoing spinal surgery.. Patient outcome after lumbar discectomy for radicular low back pain is variable and the benefit is inconsistent. The most common persistent symptoms are pain, motor deficit, and decreased functional status.. This study was conducted in 90 patients belonging to the 18 to 75 age group of either sex undergoing spinal surgery under general anesthesia. Group A received 300 mg of gabapentin, group B received 75 mg of pregabalin, whereas group C received placebo 1 dose 1 hour before surgery and 8 hourly for 7 days, thereafter. The outcome of postoperative static and dynamic pain and functional outcome was recorded using 3 questionnaires-visual analogue scale, Prolo functional and economic score, Oswestry Disability Index score from preoperative period to 3 months postoperatively.. Among the 3 groups, subjects receiving pregabalin showed consistently reduced static and dynamic pain intensity and also required lesser amount of rescue drug throughout the postoperative period. There was statistically significant difference (P < 0.05) in the Prolo score and Oswestry Disability Index score at all time intervals between group B and group C. Although, significant difference in the functional outcome between group A and group B was seen at 3 months.. Preoperative pregabalin administration is associated with less pain intensity and improved functional outcomes 3 months after lumbar discectomy followed by gabapentin and then placebo.. 2.

Topics: Adolescent; Adult; Aged; Amines; Analgesics; Cyclohexanecarboxylic Acids; Disability Evaluation; Double-Blind Method; Female; Gabapentin; gamma-Aminobutyric Acid; Humans; India; Male; Middle Aged; Orthopedic Procedures; Pain Measurement; Pain, Postoperative; Pregabalin; Prospective Studies; Quality of Life; Recovery of Function; Spine; Surveys and Questionnaires; Time Factors; Young Adult

To evaluate the efficacy and tolerability of pregabalin in postoperative pain management after laparoscopic cholecystectomy (LC).. A prospective, randomized, placebo, controlled, double-blinded study was conducted at Anesthesia Department, Laparoscopy Surgery Unit, Ain Shams University Hospital. Ninety patients with ASA physical status I-II scheduled for elective LC under general anesthesia were included. Patients were randomly assigned to the following groups (n=30 each): pregabalin group (P), received 150 mg pregabalin capsules 2 hours preoperatively, 12 hours postoperatively, and twice daily for 2 days; gabapentin group (G), received 1200 mg gabapentin capsules (400 mg, ×3) 2 hours preoperatively, 12 hours postoperatively, and 400 mg three times daily for 2 days; and control group (C), received placebo capsules. Postoperative pain scores were recorded on a visual analogue scale. The following data were recorded: total daily pethidine and diclofenac consumption, numeric sedation score, and the postoperative nausea, vomiting, and dizziness scores.. The 24-hour pethidine consumption was significantly lower (P<0.001) in both pregabalin and gabapentin groups versus control. Both groups had significantly less (P<0.001) patients with postoperative nausea, vomiting, sedation, and dizziness versus control. Overall patient satisfaction with pain management was significantly higher (P<0.001) in pregabalin group versus gabapentin or control groups.. Gabapentin 1200 mg and pregabalin 150 mg are effective and safe analgesics for reducing postoperative pain in LC. The perioperative oral administration of pregabalin 150 mg in patients undergoing LC is an effective and safe method of analgesia with a low incidence of adverse effects and reduces postoperative pethidine consumption.

Topics: Adult; Amines; Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Cholecystectomy, Laparoscopic; Cyclohexanecarboxylic Acids; Diclofenac; Dizziness; Double-Blind Method; Female; Gabapentin; gamma-Aminobutyric Acid; Humans; Male; Meperidine; Middle Aged; Pain Measurement; Pain, Postoperative; Patient Satisfaction; Postoperative Nausea and Vomiting; Pregabalin; Prospective Studies; Young Adult

Acute pain after open abdominal hysterectomy limits the function of patients in the postoperative period, but data regarding the analgesic efficacy of a low dose of pregabalin (75 or 150 mg) have been conflicting. This study was performed to determine if a low dose of pregabalin could decrease postoperative opioid use following abdominal hysterectomy when compared with placebo.. American Society of Anesthesiologists I-II patients older than 18 yr and scheduled for open elective abdominal hysterectomy were recruited for participation and randomized to one of three groups: pregabalin 75 mg (P75), pregabalin 150 mg (P150), or placebo. The study drug was administered two hours prior to surgery and 12 hr following the initial dose. Anesthetic technique and postoperative analgesia were standardized. Postoperative pain was managed using patient-controlled analgesia with morphine. Pain at rest and movement as well as nausea were assessed with an 11-point numeric rating scale.. One hundred and one patients were recruited, and 89 patients completed the study. Mean (SD) cumulative morphine consumption at 24 hr postoperatively was 54.0 (26.2) mg for the placebo group, 53.1 (22.7) mg for the P75 group, and 44.3 (20.9) mg for the P150 group. Independent Student's t tests indicated no difference between the placebo group and either the P75 group (95% confidence interval [CI]: -11.75 to 13.44; P = 0.8937) or the P150 group (95% CI: -2.74 to 22.15; P = 0.1238).. At the doses used in this study, pregabalin treatment may not be effective in reducing opioid use up to 24 hr postoperatively following abdominal hysterectomy. This trial was registered at www.ClinicalTrials.gov : NCT00781131.

Topics: Acute Pain; Adult; Analgesia, Patient-Controlled; Analgesics; Analgesics, Opioid; Dose-Response Relationship, Drug; Female; Follow-Up Studies; gamma-Aminobutyric Acid; Humans; Hysterectomy; Middle Aged; Morphine; Pain, Postoperative; Pregabalin

To evaluate the analgesic effect of pregabalin combined with intrathecal sufentanil infusion for the treatment of breakthrough pain in patients with bone metastases.. A total of 60 breakthrough pain patients with bone metastases were randomly divided to 3 groups: group A (pregabalin combined with intrathecal sufentanil infusion group, n=20), group B (placebo combined with intrathecal sufentanil infusion group, n=20) and group C (oral morphine sulfate controlled-release tablet group, n=20). The differences in visual analogue scale (VAS) between background pain and breakthrough pain, the seizure frequency of breakthrough pain, general satisfaction and side effects of the 3 groups were observed.. The seizure frequency and VAS of breakthrough pain in group A decreased significantly after the treatment (P<0.05) and the general satisfaction was the best among the the 3 groups (P<0.05), with less nausea and vomiting, constipation, drowsiness and fewer other side effects.. Pregabalin combined with intrathecal sufentanil infusion can effectively relieve breakthrough pain in patients with bone metastases.

Topics: Analgesics, Opioid; Bone Neoplasms; Breakthrough Pain; gamma-Aminobutyric Acid; Humans; Injections, Spinal; Morphine; Pain Measurement; Pain, Postoperative; Pregabalin; Sufentanil

Gabapentinoids are currently being used anecdotally for postoperative pain following photorefractive keratectomy (PRK) despite the lack of evidence. The purpose of this study is to evaluate the effectiveness of pregabalin in mitigating pain after PRK compared to the standard of care.. One hundred thirty-five patients scheduled for PRK at the Joint Warfighter Refractive Surgery Center in San Antonio, Texas were randomized to receive either oral pregabalin 75 mg twice daily for 5 days or placebo, in addition to the standard pain care regimen.. There was no statistically significant difference in the primary outcome of 10% improvement in subjective pain scores between the treatment and placebo groups at any point during the postoperative period, but there was a trend for lower subjective pain scores in the pregabalin group. There was a statistically significant difference in the frequency of rescue pain medications used on postoperative days 1 and 2. The pregabalin group required an average of 1.7 doses of rescue medications on postoperative day 1 versus 2.4 doses in the placebo group, and 1.7 doses versus 2.6 doses on postoperative day 2 (P<0.05).. This study demonstrates that pregabalin may provide an alternative or add-on option to standard narcotics for pain relief after PRK.

Topics: Administration, Oral; Adult; Analgesics; Double-Blind Method; Female; gamma-Aminobutyric Acid; Humans; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Photorefractive Keratectomy; Pregabalin; Prospective Studies; Young Adult

The purpose of this study was to determine the efficacy of pre-emptive analgesia with pregabalin and celecoxib on narcotic consumption and perceived pain in adult patients undergoing maxillomandibular advancement surgery for obstructive sleep apnea.. This was a prospective, randomized, double-blinded, placebo-controlled study of adult patients undergoing elective maxillomandibular advancement surgery for obstructive sleep apnea. The groups received a masked 1-time preoperative oral dose of pregabalin 150 mg and celecoxib 400 mg (experimental group) or lactose powder 2 g (placebo group). In the postoperative period, pain management consisted of intravenous morphine patient-controlled analgesia and oral oxycodone 5 mg and acetaminophen 325 mg. Patients completed a daily pain and narcotic log. Statistical significance between group means was determined by the 2-tailed independent t test.. There were statistically significant differences between the pregabalin plus celecoxib and placebo groups in average intravenous morphine consumption per 4-hour interval (6.0 ± 5.9 vs 9.3 ± 7.9 mg; P < .05), mean daily narcotic pill consumption (2.9 ± 2.9 vs 6.8 ± 1.8 pills; P < .05), and mean daily visual analog scale scores (4.3 ± 3.5 vs 5.5 ± 5.0; P < .05).. Within the limitations of this study, a 1-time preoperative oral dose of pregabalin and celecoxib before adult maxillomandibular advancement surgery for obstructive sleep apnea decreased mean intravenous morphine consumption, mean daily narcotic pill consumption, and mean patient perceived pain.

Topics: Acetaminophen; Administration, Intravenous; Adolescent; Adult; Analgesia, Patient-Controlled; Analgesics; Celecoxib; Cyclooxygenase 2 Inhibitors; Double-Blind Method; Follow-Up Studies; gamma-Aminobutyric Acid; Humans; Mandibular Advancement; Maxilla; Middle Aged; Morphine; Narcotics; Oxycodone; Pain Measurement; Pain, Postoperative; Placebos; Pregabalin; Premedication; Prospective Studies; Pyrazoles; Sleep Apnea, Obstructive; Sulfonamides; Treatment Outcome; Visual Analog Scale; Young Adult

We aimed to investigate the role of preoperative single dose of pregabalin for attenuating postoperative pain and analgesic consumption in patients undergoing septoplasty. One hundred forty-three patients with ASA physical status I who underwent elective septoplasty were included in this prospective, randomized, and controlled study. Subjects were randomized to receive pregabalin 75 mg, pregabalin 150 mg, and control group. All the medications were administered orally 1 hour before surgery. A standard septoplasty technique was used for all patients. Postoperative pain intensity was evaluated by a 0- to 100-mm horizontal visual analog scale (VAS) (0, no pain; 100, worst imaginable pain). Total analgesic consumption 1 to 24 h after operation was also recorded.Visual analog scale scores in the 1st, 2nd, 4th, 6th, 12th, and 24th hour were significantly decreased in 75 and 150 mg pregabalin group compared with the control group, and VAS scores in the 12th and 24th hour were significantly decreased in pregabalin 150 mg compared with 75 mg. The 24th total analgesic consumption was significantly decreased in pregabalin 75 mg and 150 mg groups compared with the control group.In conclusion, a single preoperative oral dose pregabalin 75 or 150 mg is an effective method for reducing postoperative pain and total analgesic consumption in patients undergoing septoplasty.

Topics: Adult; Analgesics; Female; gamma-Aminobutyric Acid; Humans; Male; Pain Measurement; Pain, Postoperative; Pregabalin; Preoperative Care; Prospective Studies; Rhinoplasty; Treatment Outcome

A prospective and randomized study.. The objective of this study was to assess the efficacy of a novel multimodal analgesic regimen in reducing postoperative pain and intravenous morphine requirements after primary multilevel lumbar decompression surgery.. The use of opioid medications after surgery can lead to incomplete analgesia and may cause undesired side effects such as respiratory depression, somnolence, urinary retention, and nausea. Multimodal (opioid and nonopioid combination) analgesia may be an effective alternative to morphine administration leading to improved postoperative analgesia with diminished side effects.. After Institutional Review Board approval, 22 patients who underwent a primary multilevel lumbar decompression procedure were randomly assigned to receive either only intravenous morphine or a multimodal (celecoxib, pregabalin, extended release oxycodone) analgesic regimen. Postoperatively, all patients were allowed to receive intravenous morphine on an as needed basis. Intravenous morphine requirements were then recorded immediately postoperative, at 6, 12, 24 hours, and the total requirement before discharge. Patient postoperative pain levels were determined using the visual analog pain scale and were documented at 0, 4, 8, 12, 16, 24, and 36 hours postoperative.. There were no significant differences in available patient demographics, intraoperative blood loss, or postoperative hemovac drain output between study groups. Total postoperative intravenous morphine requirements in addition to morphine requirements at all predetermined time points were less in patients randomized to receive the multimodal analgesic regimen. Visual analog pain scores were lower at all postoperative time points in patients randomized to receive the multimodal analgesic regimen. Time to solid food was significantly less in the multimodal group. There were no major identifiable postoperative complications in either treatment group.. Opioid and nonopioid analgesic combinations appear to be safe and effective after lumbar laminectomy. Patients demonstrate lower intravenous morphine requirements, better pain scores, and earlier time to solid food intake.

Topics: Aged; Aged, 80 and over; Analgesics; Celecoxib; Decompression, Surgical; Drug Therapy, Combination; Female; gamma-Aminobutyric Acid; Humans; Lumbar Vertebrae; Male; Middle Aged; Morphine; Oxycodone; Pain Measurement; Pain, Postoperative; Pregabalin; Prospective Studies; Pyrazoles; Sulfonamides; Treatment Outcome

We investigated the effect of a combination of pregabalin and dexamethasone, when used as part of a multimodal analgesic regimen, on pain control after rhinoplasty operations.. Sixty patients were enrolled in this study. They were randomly assigned into three groups: Group C (placebo + placebo), Group P (pregabalin + placebo), and Group PD (pregabalin + dexamethasone). Patients received either pregabalin 300 mg orally 1 h before surgery, dexamethasone 8 mg intravenously during induction, or placebo according to their allocation. Postoperative pain was treated with intravenous patient-controlled analgesia (tramadol, 20-mg bolus dose, 45-min lockout time). The numeric rating scale (NRS), side effects, and consumption of tramadol, pethidine, and ondansetron were assessed.. The median NRS scores at 0, 1, and 6 h after surgery were significantly higher in Group C than in Group PD (p < 0.001 for all). The 24-h consumption of tramadol and pethidine was significantly reduced in Groups P and PD compared to Group C (p < 0.01 and p < 0.01). The total tramadol consumption was decreased by 54.5 % in Group P and 81.9 % in Group PD compared to Group C (p < 0.001 for both). The incidence of nausea was higher in Group C than in Groups P and PD between the postoperative 0-2 and 0-24-h periods (p < 0.05 for both). The frequency of blurred vision was significantly higher in Groups P and PD than in Group C within the 0-24-h period (p < 0.05 for both).. We found that the addition of a single dose of pregabalin and dexamethasone to multimodal analgesia in rhinoplasty surgeries provided efficient analgesia and thus decreased opioid consumption.. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Topics: Adolescent; Adult; Aged; Analgesia; Analysis of Variance; Dexamethasone; Double-Blind Method; Drug Therapy, Combination; Female; Follow-Up Studies; gamma-Aminobutyric Acid; Humans; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Pregabalin; Preoperative Care; Prospective Studies; Reference Values; Rhinoplasty; Risk Assessment; Severity of Illness Index; Treatment Outcome; Young Adult

In this study, effects of pregabaline on postoperative pain and opioid consumption used perioperatively in patients undergoing modified radical mastectomy(MRM) were investigated.. Sixty ASA 1-2 patients scheduled for MRM were included. Patients were randomly divided into two and 30 patients were allocated into each group. Group Pregabaline was given pregabaline 150 mg 1 hr before operation and Group Placebo empty capsule. In both groups, anesthesia induction was obtained by penthotal, fentanyl and rocuronium and maintainence by sevoflurane, N2O and O2. Twelve hr after operation, Group Pregabaline was administered pregabaline 75 mg while Placebo group received empty capsule again. All patients received lornoxicam 8 mg iv 1 hr before end of surgery and ondansetrone 4 mg 30 min before. Patient-controlled analgesia device prepared with morphine was connected to both groups for postoperative analgesia. Postoperative VAS pain scores, hemodynamic parameters, morphine consumption, side-effects like nausea-vomiting, sedation and dizziness were followed and recorded.. Demographic parameters were similar. VAS scores were significantly lower in Group Pregabaline at 1, 30 min, 1,4,8 and 12 hr (p<0.05). There was no significant difference in postoperative morphine consumption and need for additional dose, although they were higher in Placebo group. The patients in Placebo group had higher bothersome scores for side-effects. Hemodynamic parameters and other side-effects were similar.. In our study, we showed that pregabalin administered perioperatively increased postoperative analgesic efficacy in MRM operations without making significant side effect, but did not change opioid consumption. We think that further studies about this topic must be held with different dose and patient groups.

Topics: Adult; Analgesics; Analgesics, Opioid; Breast Neoplasms; Female; gamma-Aminobutyric Acid; Humans; Intraoperative Period; Mastectomy, Modified Radical; Middle Aged; Morphine; Pain Measurement; Pain, Postoperative; Pregabalin

In this randomized-controlled study, we investigated the effects of combined administration of pregabalin and dexamethasone on postoperative pain and analgesic requirements, and functional outcome in patients who underwent lumbar spinal surgery.. One hundred eight patients were randomized to group C (placebo+placebo), group P (pregabalin + placebo), or group PD (pregabalin+dexamethasone). According to their allocated group, patients received placebo or pregabalin 150 mg every 12 hours starting 1 hour before anesthetic induction for a total of 8 doses. Dexamethasone 16 mg or normal saline was injected before the induction of anesthesia. The pain intensity, analgesic requirements, and side effects were assessed in the postoperative period: postanesthesia care unit, 12, 24, 48, and 72 hours. Pain intensity and daily activity performance were also assessed 1, 3, and 6 months after surgery.. Compared with group C, the pain scores were lower in group PD at 24 hours after surgery (P = 0.011). The frequency of additional rescue analgesic administration was significantly lower in group PD until 48 hours after surgery (P < 0.05) and in group P at 24 to 48 hours (P = 0.005) relative to group C. Back pain intensity at work was lower (P = 0.048) and daily activity performance was better (P = 0.006) in group PD compared with group C at 1 month after surgery.. Combined administration of pregabalin and dexamethasone conferred analgesic benefits superior to those of pregabalin alone. This regimen also helped facilitate return to normal daily activity after surgery.

Topics: Activities of Daily Living; Adult; Aged; Analgesics; Anti-Inflammatory Agents; Dexamethasone; Drug Therapy, Combination; Female; gamma-Aminobutyric Acid; Humans; Laminectomy; Lumbar Vertebrae; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Placebo Effect; Pregabalin; Premedication; Recovery of Function; Republic of Korea; Treatment Outcome; Young Adult

Postoperative pain is the dominant complaint and the most common cause of delayed discharge after laparoscopic cholecystectomy. The aim of this study is to evaluate the potential of preoperative administration of pregabalin to reduce postoperative pain and opioid consumption.. Fifty American Society of Anesthesiologists (ASA) I and II adult patients with symptomatic gallstone disease scheduled for elective laparoscopic cholecystectomy were randomized into two groups: group I patients (n = 25) were given 600 mg pregabalin per os divided in two doses, the night before surgery and 1 h preoperatively, respectively, while group II patients (n = 25) received a matching to pregabalin placebo at the same scheme. Postoperative pain, morphine consumption, and complications were compared between the two groups.. Postoperative pain (static and dynamic assessment) was significantly less at 0, 1, 8, 16, and 24 h (p < 0.001) after the procedure for group I (pregabalin) compared with the placebo group. Postoperative patient-controlled morphine consumption during hospital stay was also significantly less in the pregabalin group compared with the placebo group. Side-effects were similar in both groups expect for dizziness, which was significantly higher (p < 0.0001) in the pregabalin group.. Administration of 600 mg pregabalin per os, divided in two preoperative doses, significantly reduces postoperative pain as well as opioid consumption in patients undergoing laparoscopic cholecystectomy, at the cost of increased incidence of dizziness.

Topics: Adolescent; Aged; Analgesia, Patient-Controlled; Analgesics; Analgesics, Opioid; Cholecystectomy, Laparoscopic; Dizziness; Double-Blind Method; Drug Utilization; Female; gamma-Aminobutyric Acid; Humans; Male; Morphine; Pain, Postoperative; Pregabalin; Premedication; Visual Analog Scale

This double-blind randomized crossover study compared the analgesic efficacy of pre- and postoperative administration of oral pregabalin 75 mg using a postsurgical dental pain model.. Patients requiring third molar surgery in 2 separate stages under local anesthesia were recruited. They were given pregabalin 75 mg either 1 hour before or after their first surgical extraction. They then received the same dose of pregabalin at their second surgical extraction, but those who received it before surgery received it postsurgery, and vice versa. Postoperative analgesic effects were assessed at postoperative hours 2, 4, 8, 12, 24, 48, and 72. Time to first analgesic, analgesic consumption and adverse events were also evaluated.. Forty patients were recruited, and 34 completed the study. The area under curves for numerical rating scale pain scores 1 to 24 hours were significantly lower at rest but not during mouth opening for patients receiving postoperative pregabalin (P < .048). Pain relief was similar for the period of 24 to 72 hours. No significant difference was found in time to first analgesic, total analgesic consumption, and side effects between preoperative and postoperative groups. No difference in the incidence of adverse events was noticed in relation to the timing of pregabalin administration.. Postoperative administration of oral pregabalin 75 mg appears to offer better analgesic efficacy than preoperative administration after third molar surgery under local anesthesia.

Topics: Acetaminophen; Administration, Oral; Adolescent; Adult; Analgesics; Analgesics, Non-Narcotic; Analgesics, Opioid; Anesthesia, Dental; Anesthesia, Local; Cross-Over Studies; Dextropropoxyphene; Double-Blind Method; Female; gamma-Aminobutyric Acid; Humans; Male; Molar, Third; Pain Measurement; Pain, Postoperative; Placebos; Pregabalin; Premedication; Time Factors; Tooth Extraction; Tooth, Impacted; Treatment Outcome; Young Adult

Adequate management of postoperative pain after major spine surgery is often difficult to achieve. We investigated the efficacy of an antineuropathic pain drug, pregabalin (PG), on postoperative pain control and on improvement of quality of life (QoL).. Sixty patients scheduled for elective decompressive spine surgery were enrolled. One hour before surgery patients received 300 mg of either oral PG or placebo (PL) and 150 mg of PG or PL twice a day for 48 hours postoperatively. During the first 48 postoperative hours, a continuous infusion of morphine 0.01 mg/kg/h and ketorolac tromethamine 2.5 mg/h was administered. Intravenous morphine in 2-mg aliquots up to a maximum of 10 mg was used as rescue therapy. Pain was measured at rest and during movement using a visual analog scale (VAS score), and side effects were recorded in the first hour and at 4, 8, 12, 24, and 48 hours. Three months and 1 year after discharge, patients were contacted by telephone by 1 of the authors to obtain follow-up information using the EuroQoL questionnaire.. During the first 8 postoperative hours, VAS scores at rest were significantly lower in the PG group than in the PL group (P<0.05), whereas VAS scores on movement were significantly lower up to 12 hours after the operation in the PG group (P<0.05). The morphine consumption in the PG group was 3±2 mg, whereas in the PL group it was 9.5±2.5 mg (P<0.05). Postoperative incidence of constipation and nausea/vomiting was higher in the PL group than in the PG group. No significant differences between the 2 groups were observed with regard to other adverse effects. QoL measures revealed an improvement in outcome, especially in movement and in pain dimensions in both groups; however, at 3 months, subjective qualification of overall QoL was better in the PG group than in the PL group. There were no differences in QoL after the 1-year follow-up period.. Perioperative PG administration reduces early postsurgical pain at rest and particularly during movement after major spine surgery with less opioid consumption, and it seems to influence the improvement of overall QoL 3 months after surgery.

Topics: Aged; Analgesics; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Double-Blind Method; Drug Administration Schedule; Female; Follow-Up Studies; gamma-Aminobutyric Acid; Humans; Ketorolac Tromethamine; Male; Middle Aged; Morphine; Pain Measurement; Pain, Postoperative; Perioperative Care; Pregabalin; Prospective Studies; Quality of Life; Spine; Surveys and Questionnaires; Treatment Outcome

Total knee replacement (TKR) is of enormous benefit to patients with osteoarthritis of the knee; however, the acute postoperative pain can be severe and difficult to manage. The role of major spinal cord neurotransmitters in this acute postoperative period is not clear, although there are a few studies in humans. We performed the first prospective clinical study undertaken to delineate the changes in the spinal neurotransmitters after a surgery such as TKR. Furthermore, we also determined whether antihyperalgesic drugs at clinically acceptable doses modulate spinal neurotransmitter concentrations in patients during the perioperative period.. All patients had a spinal needle placed in the lumbar region and cerebrospinal fluid (CSF) obtained for baseline measurement of the neurotransmitters. An intrathecal catheter was then placed for spinal anesthesia for standard TKR and for continuous spinal postoperative analgesia. The spinal catheter was also used postoperatively to sample CSF at 2, 4, 8, 12, 24, and 32 hours after catheter placement. CSF samples were assayed for norepinephrine, substance P, calcitonin gene-related peptide (CGRP), and glutamate concentrations. SF-36 (36-item Short Form Health Survey) was measured preoperatively. Numerical rating scale (NRS) pain scores and intrathecal analgesic consumption were recorded postsurgery at 4-hour intervals for 32 hours. We performed a randomized, placebo-controlled, double-blind trial with 3 drug groups (n = 16 per group): placebo; single-dose pregabalin (150 mg administered before surgery); and multidose pregabalin (150 mg administered presurgery and 12 and 24 hours later), to determine the effect of an antihyperalgesic drug such as pregabalin on spinal neurotransmitters.. Forty-eight patients were randomly assigned to the 3 perioperative treatment groups, and multiple CSF samples were successfully obtained from 44 patients. Before surgery, increased bodily pain (from preoperative SF-36 measure) was correlated with increased CSF norepinephrine concentration (P = 0.044). Compared with presurgery values, norepinephrine levels were lower in the placebo group at the 2- and 4-hour time points (P < 0.005) whereas in the single and multidose groups, the reduction (P < 0.001) continued until 12 and 24 hours, respectively. Substance P CSF levels had an early peak value (at 2 hours) in all 3 groups, and then returned to baseline. Compared with baseline value, the CGRP CSF levels only decreased at the 32-hour time point in the placebo group, but in both pregabalin groups, CGRP levels decreased over the 4- to 32-hour period. In the placebo group only, CSF glutamate decreased over 4 to 32 hours compared with presurgery values. However, there was no difference in the CSF neurotransmitter concentrations among the 3 treatment groups over the 32-hour sampling period. In the placebo group, the early NRS pain score area under the curve, AUC [0-12 hours], was positively correlated (R = 0.67, P = 0.0088) with the CSF norepinephrine concentration AUC [12-24 hours], but none of the other neurotransmitters was correlated with the NRS. None of the CSF neurotransmitter concentrations correlated with postoperative analgesic consumption.. In the perioperative period, the concentration changes of the 4 spinal neurotransmitters have a distinct time course. CSF substance P seems to increase very rapidly with surgical intervention, whereas the CSF norepinephrine concentration tends to decrease. At clinical doses, pregabalin does not seem to modulate these spinal neurotransmitter concentrations.

Topics: Aged; Analgesia; Analgesia, Patient-Controlled; Analgesics; Arthroplasty, Replacement, Knee; Calcitonin Gene-Related Peptide; Chicago; Drug Administration Schedule; Female; gamma-Aminobutyric Acid; Glutamic Acid; Humans; Male; Middle Aged; Norepinephrine; Pain Measurement; Pain, Postoperative; Perioperative Period; Pregabalin; Prospective Studies; Spinal Puncture; Substance P; Time Factors; Treatment Outcome

Preoperative administration of pregabalin is proposed as a promising way of enhancing postoperative pain control. Whereas a few studies have investigated the effect of pregabalin on postoperative opioid consumption, no study has focused on the influence on postoperative hyperalgesia. In this randomized, triple-blinded, placebo-controlled study, we aimed to demonstrate that a single, preoperative dose of pregabalin reduces postoperative opioid consumption, mechanical hyperalgesia, and pain sensitivity.. Patients undergoing elective transperitoneal nephrectomy received 300 mg pregabalin or placebo 1 h before anaesthesia. After operation, patients received piritramide via a patient-controlled analgesia device. Pain levels and side-effects were documented. The area of hyperalgesia for punctuate mechanical stimuli around the incision was measured 48 h after the operation with a hand-held von Frey filament. Mechanical pain threshold was tested before and 48 h after surgery with von Frey filaments with increasing diameters.. In each group, 13 patients were recruited. Total piritramide consumption [77 (16) vs 52 (16) mg, P=0.0004] and the normalized area of hyperalgesia [143 (87) vs 84 (54) cm(2), P=0.0497] were significantly decreased in the pregabalin group. There were no significant differences in mechanical pain threshold levels [1.20 (0.56) log(g) vs 1.05 (0.58) log(g), P=0.6738]. No case of severe sedation was reported in both groups. No other side-effects were observed.. Our study has shown that preoperative administration of 300 mg pregabalin in patients undergoing transperitoneal nephrectomy reduces postoperative opioid consumption and decreases the area of mechanical hyperalgesia.

Topics: Adult; Aged; Analgesics, Non-Narcotic; Analgesics, Opioid; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Female; gamma-Aminobutyric Acid; Humans; Hyperalgesia; Male; Middle Aged; Nephrectomy; Pain Measurement; Pain Threshold; Pain, Postoperative; Preanesthetic Medication; Pregabalin

To determine the efficacy of two different doses (150 mg and 300 mg) of preoperative pregabalin on pain relief and total opioid consumption after laparoscopic cholecystectomy.. Prospective, randomized, placebo-controlled, double-blinded study.. Training and research hospital.. 90 adult, ASA physical status 1 and 2 patients.. Patients were randomly assigned to three groups to receive orally one hour before surgery, a placebo (Group 1), pregabalin 150 mg (Group 2), or pregabalin 300 mg (Group 3). Patients were observed for pregabalin side effects, somnolence via Ramsay Sedation Scale, dizziness, confusion, and ataxia.. In the operating room, heart rate and noninvasive systolic and diastolic blood pressures were measured. Visual analog scale (VAS), Ramsay Sedation Scale, and Aldrete scores were also recorded on arrival at the Postanesthesia Care Unit (time 0), 15, 30, 60, 120 minutes and 3, 4, 6, 8, 10, 12 and 24 hours after surgery. Additional doses of drugs (fentanyl and/or metoclopramide) were also recorded.. Preemptive pregabalin decreased pain scores and postoperative fentanyl consumption in patients after laparoscopic cholecystectomy in a dose-dependent manner. There were no differences between the groups in side effects.. Preoperative pregabalin may be a useful analgesic for patients after laparoscopic cholecystectomy, as it lowers pain intensity and opiod consumption, and does not increase the frequency of side effects.

Topics: Administration, Oral; Adult; Aged; Analgesics; Analgesics, Opioid; Cholecystectomy, Laparoscopic; Dose-Response Relationship, Drug; Double-Blind Method; Female; Fentanyl; gamma-Aminobutyric Acid; Humans; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Pregabalin; Prospective Studies; Time Factors

To evaluate the efficacy of pregabalin and gabapentin for reducing post-photorefractive keratectomy (PRK) pain.. In this randomized clinical trial, 150 subjects undergoing PRK were allocated into 3 groups. In addition to the routine regimen, pregabalin 75 mg, gabapentin 300 mg, and placebo were administered 3 times daily for 3 days, in groups 1, 2, and 3, respectively. Subjects could take acetaminophen-codeine 300/10 mg tablets every 4 hours as needed. Patients completed a pain assessment survey (visual analogue scale ranging from 0 = no pain to 10 = most severe pain) 7 times in the first 3 days following PRK and also recorded the number of consumed acetaminophen-codeine tablets.. Age, sex, refractive error, ablation depth, and mitomycin-C (MMC) application were similar in the 3 study groups (all p values>0.05). Overall pain scores in the placebo group were 0.9 and 1 unit higher than the pregabalin (p=0.029) and gabapentin (p=0.023) groups, respectively. Severe pain (score >7) was more frequent in the placebo group on the morning of the first postoperative day (p=0.043). The difference in the number of consumed acetaminophen-codeine tablets was statistically borderline (p=0.061) and less in the pregabalin (7.9 ± 5.2) and gabapentin (9.0 ± 4.1) groups in comparison to the placebo group (10.3 ± 5.6).. Pregabalin and gabapentin seem to be helpful in alleviating post-PRK pain when combined with other measures. Depending on availability, either compound can be used as an adjuvant for pain control in this setting.

Topics: Acetaminophen; Administration, Oral; Adult; Amines; Analgesics; Codeine; Cyclohexanecarboxylic Acids; Double-Blind Method; Drug Combinations; Drug Therapy, Combination; Eye Pain; Female; Gabapentin; gamma-Aminobutyric Acid; Humans; Male; Pain Measurement; Pain, Postoperative; Photorefractive Keratectomy; Pregabalin; Prospective Studies; Treatment Outcome; Young Adult

Multimodal analgesia increases the chance of successful discharge and pain control after surgery, and pregabalin is being promoted as an effective analgesic, based on placebo-controlled studies. We investigated whether adding pregabalin improved pain control and reduced opioid requests when it was added to a multimodal analgesic regimen for cosmetic surgery.. One hundred and ten women who underwent same-day cosmetic surgery were randomized to receive oral pregabalin, 75 mg q12 h for five consecutive days starting the night before surgery, or identical placebos. Participants, outcomes assessors, and the statistician were blinded. The primary outcome was postoperative numerical movement-evoked pain scores at 2, 24, 48, 72, and 96 h after surgery. The secondary outcomes included pain scores at rest; incidence of moderate to severe pain; and analgesic and antiemetic requirements; as well as the incidence of nausea, vomiting, and somnolence.. Based on 99 patients who completed the study, we found no difference between the groups in the primary outcome; 72 h after surgery, movement-evoked median pain scores were <4/10 in both groups. We found no differences in opioid requirements (p = 0.95) or anti-inflammatory requirements (p = 0.45), and no difference in opioid-related adverse events.. Perioperative pregabalin 75 mg twice a day does not increase benefit when it is added to an already multimodal analgesic regimen for patients undergoing cosmetic surgery. Several factors could explain our findings, including the possibility of publication bias in the current literature.

Topics: Adolescent; Adult; Analgesics; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Double-Blind Method; Drug Therapy, Combination; Female; gamma-Aminobutyric Acid; Humans; Lipectomy; Middle Aged; Pain Measurement; Pain, Postoperative; Postoperative Nausea and Vomiting; Pregabalin; Sample Size; Surgery, Plastic; Treatment Outcome; Young Adult

The antiepileptics gabapentin and pregabalin are used as adjuvants to control postoperative pain.. The aim of the present study was to investigate the effect of perioperative administration of pregabalin on postoperative acute and chronic pain and analgesic requirements.. Department of Anaesthesiology, Aretaieio University Hospital, Athens, Greece.. Eighty patients scheduled for abdominal hysterectomy or myomectomy were randomly assigned to the pregabalin or to the control group.. The pregabalin group received 150 mg of pregabalin 8-hourly, starting on the afternoon before surgery and continued until the fifth postoperative day. The control group was similarly treated, but received placebo capsules instead.. Postoperative intravenous morphine and Lonalgal (30 mg codeine with 500 mg paracetamol) tablet consumption, visual analogue pain scores at rest and on coughing, sedation, anxiety, dizziness, ataxia, blurred vision and diplopia were recorded. One and 3 months postoperatively patients were interviewed for the presence of pain and analgesic needs due to surgery.. The pregabalin-treated patients consumed less morphine during the first 48 h postoperatively (P = 0.0001). However, consumption of Lonalgal tablets and visual analogue scores for pain at rest and on coughing did not differ between the groups. No difference was found in sedation and anxiety scores between the patients who received placebo or pregabalin. Patients in the control group had lower incidences of dizziness (29 versus 58%, P = 0.015), ataxia (0 versus 18%, P = 0.011), blurred vision (6 versus 26%, P = 0.028) and diplopia (0 versus 16%, P = 0.023). Presence of pain, analgesic intake due to surgery and decreased or absent sensation around the wound did not differ between the groups 1 and 3 months postoperatively.. Pregabalin in the doses given decreased morphine requirements for the first 48 h postoperatively, but neither altered the analgesic requirements beyond 48 h nor had any effect on acute, late or chronic pain.

Topics: Acetaminophen; Acute Pain; Adult; Analgesics; Chronic Pain; Codeine; Double-Blind Method; Drug Combinations; Female; gamma-Aminobutyric Acid; Greece; Humans; Hysterectomy; Middle Aged; Morphine; Pain, Postoperative; Perioperative Care; Pregabalin; Time Factors; Uterine Myomectomy

To evaluate the analgesic effect of perioperative administration of pregabalin in patients undergoing arthroscopic anterior cruciate ligament reconstruction.. Fifty-six patients were randomly assigned to receive either pregabalin 75 mg or a matching placebo, one hour prior to spinal anesthesia, with the second dose repeated 12 hours after the first dose in this comparative study. The means of postoperative pain intensity measured by a verbal rating scale (VRS) of 0 to 10, sedation score of 0 to 3, requirement for morphine using a patient-controlled analgesia (PCA) device, and the median respiratory rate, as well as adverse effect were recorded every four-hour up to 24 hours.. Twenty-seven patients received pregabalin, and 29 cases got placebo. Characteristics were not significantly different between the two groups, except for the ages of 29.3 years in the pregabalin group, and 33.8 years in the placebo group. The means of postoperative pain severity, sedation score, consumption of PCA morphine, median respiratory rate, and adverse effects were not significantly different between the two groups.. Perioperative administration of pregabalin was not superior to placebo in terms of reducing postoperative pain intensity and PCA morphine requirement in patients undergoing arthroscopic anterior cruciate ligament reconstruction.

Topics: Adolescent; Adult; Aged; Analgesics; Anterior Cruciate Ligament Reconstruction; Arthroscopy; Drug Administration Schedule; Female; gamma-Aminobutyric Acid; Humans; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Perioperative Care; Pregabalin; Young Adult

Preoperative anxiety can increase postoperative pain and is therefore important to avoid. Different approaches have already been tested for preoperative anxiolysis. Gabapentinoids might be a useful alternative to benzodiazepines. Pregabalin is used for treating generalized anxiety disorders and shows a favourable pharmacokinetic profile after oral administration; however, its anxiolytic effect preoperatively in healthy outpatients is still unclear. In this randomised, double-blind, placebo-controlled trial the anxiolytic effect of pregabalin in 40 outpatients undergoing standardised general anaesthesia and postoperative pain therapy for minor orthopaedic surgery was analysed. Patients received preoperatively either 300 mg pregabalin or placebo orally. The primary outcome was anxiety before anaesthesia induction, the secondary outcome the postoperative pain, both assessed using a visual analogue scale from 0 to 100. Without any side effects pregabalin reduced preoperative anxiety compared with the control group (23 ± 10 vs. 38 ± 17; p = 0.003). Pain scores did not differ between groups; however, need of piritramide in the postanaesthesia care unit was reduced to half by pregabalin compared with the control group. A single preoperative dose of 300 mg pregabalin reduces anxiety in patients undergoing minor orthopaedic surgery without any side effects like dizziness or persisting sedation resulting in a prolonged stay in the postanaesthesia care unit.

Topics: Adult; Analgesics, Opioid; Anti-Anxiety Agents; Anxiety; Double-Blind Method; Female; gamma-Aminobutyric Acid; Humans; Male; Middle Aged; Minor Surgical Procedures; Orthopedics; Pain Measurement; Pain, Postoperative; Pirinitramide; Pregabalin; Preoperative Care

Pregabalin is used for the treatment of neuropathic pain and has shown analgesic efficacy in post-operative pain. The aim of this randomized, double-blinded, placebo-controlled trial (Clinical Trials.gov ID NCT00938548) was to investigate the efficacy and safety of pregabalin for reducing post-operative pain in patients after mastectomy.. Eighty-four women scheduled for elective mastectomy were randomly assigned to groups that received either pregabalin (75 mg) or placebo, 1 h before surgery and 12 h after the initial dose. Assessments of pain [verbal numerical rating scale (VNRS), at rest and with arm abduction] and side effects were performed at 1, 6, 24 and 48 h post-operatively. After discharge from the hospital, pain was assessed by telephone interview at post-operative 1 week and 1 month.. VNRS scores for pain at rest were lower in the pregabalin group (n=42) than the placebo group (n=42) at 1, 24 and 48 h post-operatively (P<0.05). VNRS scores for pain with arm abduction were lower in the pregabalin group (n=42) than the placebo group (n=42) at 1 and 24 h, and 1 week post-operatively (P<0.05). Incidences of side effects such as nausea and vomiting, headache, dizziness and blurred vision were similar in both groups.. Perioperative administration of pregabalin for a single day (75 mg twice daily) was easy, safe and effective in reducing post-operative pain in patients undergoing mastectomy.

Topics: Adult; Analgesics; Double-Blind Method; Female; gamma-Aminobutyric Acid; Humans; Mastectomy; Middle Aged; Pain Measurement; Pain, Postoperative; Pregabalin

Post-tonsillectomy pain can be severe. We investigated the analgesic effect from combinations of paracetamol, pregabalin and dexamethasone in adults undergoing tonsillectomy.. In this randomized double-blind study, 131 patients were assigned to either group A (paracetamol+placebo), group B (paracetamol+pregabalin+placebo) or group C (paracetamol+pregabalin+dexamethasone). Pre-operatively, patients received either paracetamol 1000 mg, pregabalin 300 mg, dexamethasone 8 mg or placebo according to their allocation. Post-operative pain treatment included paracetamol 1000 mg 4× and ketobemidone 2.5 mg p.n. Ketobemidone consumption, pain scores [visual analogue scale (VAS)], nausea, sedation, dizziness, number of vomits and consumption of ondansetron were recorded 2, 4 and 24 h after the operation. P<0.05 was considered statistically significant.. The mean 24-h VAS-pain score at rest was reduced in group C (P<0.003) vs. group A. The mean 24-h VAS-pain scores during swallowing were reduced in group B (P=0.009) and group C (P<0.003) vs. group A. Consumption of ketobemidone (1-4 h post-operatively) was lower in group B (P=0.003) and group C (P=0.003) vs. group A. The mean 24-h dizziness score was higher in group B (P<0.003) and C (P=0.003) vs. group A. Other parameters including re-operation for post-tonsillectomy bleeding were not different between groups.. Pregabalin and pregabalin+dexamethasone reduced post-operative pain scores and consumption of ketobemidone following tonsillectomy. Dizziness was increased with pregabalin.

Topics: Acetaminophen; Adult; Analgesics; Dexamethasone; Double-Blind Method; Drug Therapy, Combination; Female; gamma-Aminobutyric Acid; Humans; Male; Pain Measurement; Pain, Postoperative; Pregabalin; Prospective Studies; Tonsillectomy

A prospective, randomized, controlled, and double-blind trial.. To evaluate the effects of 2 different doses of perioperative pregabalin administration, twice on the day of surgery, on acute postoperative pain after spinal surgery.. Besides its well-established role on neuropathic pain, pregabalin seems to be a promising adjunct to multimodal analgesic regimen following surgery. No comprehensive data exist regarding the optimal dosage of pregabalin on reducing postoperative pain and opioid consumption in spinal surgery.. Patients were randomly assigned to 1 of 3 groups. The placebo group (n = 28) received placebo capsules 1 hour before the anesthetic induction and 12 hours after surgery. The pregabalin groups received pregabalin 75 mg (P75 group, n = 28) or 150 mg (P150 group, n = 28), respectively at the same points. Assessed variables were total amount of administered fentanyl-based intravenous patient-controlled analgesia, pain intensity, and the frequency of rescue analgesic administered during the first 48 hours after surgery, subdivided into the following 4 periods: on arrival of patient to the postanesthesia care unit, 1 to 6 hours, 6 to 24 hours, and 24 to 48 hours. RESULTS.: The amount of patient-controlled analgesia volume infused until 24 hours (P 5 0.025) and 48 hours (P 5 0.028) after surgery was significantly less in the P150 group compared with the control group. The frequency of additional anodynes administered until 6 hours (P 5 0.049) and 24 hours (P 5 0.045) after surgery was significantly less in the P150 group compared with the control group.. Perioperative administration of pregabalin 150 mg before and 12 hours after surgery, but not 75 mg, significantly reduced opioid consumption and the use of additional pain rescue for 48 hours after surgery without significant side effects in patients undergoing spinal fusion surgery.

Topics: Adult; Analgesics; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Female; gamma-Aminobutyric Acid; Humans; Lumbar Vertebrae; Male; Middle Aged; Pain, Postoperative; Perioperative Care; Pregabalin; Prospective Studies; Spinal Fusion; Time Factors; Treatment Outcome

Pregabalin acts as a membrane stabilizer and has both analgesic and anxiolytic effects. We hypothesized that one pre-operative dose of pregabalin would reduce pre-operative anxiety and post-operative pain in patients undergoing discectomy.. We performed a randomized, placebo-controlled study of 150 mg pregabalin administered before lumbar discectomy in general anaesthesia. The primary endpoint was pain at rest [visual analogue scale (VAS)] 120 min after surgery. The secondary outcomes were morphine consumption, pre-operative anxiety (VAS) and the occurrence of side effects.. The VAS scores for pain at rest and morphine consumption were higher in the placebo group during the 4-h stay in the post-anaesthetic care unit (PACU), but did not differ significantly 24 h after surgery. Pain scores at 7 days were similar and there was no difference in the occurrence of side effects. Pre-operative anxiety was significantly lower in the pregabalin group (2.23±1.11 vs. 4.17±2.37, 95% confidence interval: 0.82-3.05, P=0.001) and there was a significant positive correlation between the pre-operative anxiety score and post-operative pain at 120 min in the pregabalin group.. A single dose of pregabalin (150 mg) reduced post-operative pain at rest and morphine consumption during the PACU period after lumbar discectomy. Pre-operative anxiety was lower, without increased incidence of side effects.

Topics: Adult; Analgesia, Patient-Controlled; Analgesics; Analgesics, Opioid; Anesthesia, Intravenous; Anxiety; Diskectomy; Double-Blind Method; Endpoint Determination; Female; gamma-Aminobutyric Acid; Humans; Male; Middle Aged; Morphine; Pain Measurement; Pain, Postoperative; Postoperative Complications; Pregabalin; Preoperative Period; Sample Size; Treatment Outcome

In this prospective, randomized, double-blind, placebo-controlled study, we investigated the effect of pregabalin on oxycodone consumption, postoperative confusion, and pain in elderly cardiac surgery patients.. Seventy patients, aged ≥75 yr, were randomized to receive either 150 mg of pregabalin before operation and 75 mg of pregabalin twice daily for 5 postoperative days or placebo. Pain intensity was measured with the Verbal Rating Scale (VRS). When pain intensity was ≥2 on the VRS, patients received oxycodone either i.v. (0.05 mg kg(-1)) or orally (0.10-0.15 mg kg(-1)). Postoperative confusion was measured with the Confusion Assessment Method for the intensive care unit (CAM-ICU). Postoperative pain was assessed by a telephone interview 1 and 3 months after operation.. Cumulative consumption of parenteral oxycodone during 16 h after extubation was reduced by 44% and total oxycodone consumption from extubation to the end of the fifth postoperative day was reduced by 48% in the pregabalin group. Time to extubation was 138 min shorter and CAM-ICU scores were significantly lower on the first postoperative day in the placebo group, although there was no significant difference with respect to the Mini-Mental State Examination or the Richmond Agitation Sedation Score. The incidence of pain during movement was significantly lower in the pregabalin group at 3 months postoperative.. The administration of pregabalin reduced postoperative opioid consumption after cardiac surgery reduced the incidence of confusion on the first postoperative day and increased time to extubation when compared with placebo. Three months after operation, patients in the pregabalin group experienced less pain during movement.

Topics: Aged; Aged, 80 and over; Analgesics, Non-Narcotic; Analgesics, Opioid; Cardiac Surgical Procedures; Confusion; Drug Administration Schedule; Drug Therapy, Combination; Epidemiologic Methods; Female; gamma-Aminobutyric Acid; Humans; Male; Oxycodone; Pain Measurement; Pain, Postoperative; Postoperative Care; Postoperative Complications; Postoperative Nausea and Vomiting; Pregabalin

Gabapentin and pregabalin have been compared in studies conducted on management of neuropathic and postoperative pain. In neuropathic pain studies, the analgesic effects of the two drugs were compared, and pregabalin has been found to be more potent. However, in postoperative pain studies, the effects of each drug were examined separately. This study compared the analgesic effects of pregabalin (300 mg day-1), gabapentin (1,200 mg day-1) and a placebo in managing postoperative pain following laminectomy and discectomy.. 90 patients were randomly assigned to three groups (pregabalin, gabapentin and placebo) of 30 patients each. Pregabalin 150 mg, gabapentin 600 mg and a placebo were administered every 12 hours, two times pre- and post surgery. Study data collected included morphine consumption, Visual Analogue Scale records, preoperative anxiety, patient satisfaction, adverse effects and observation notes.. In the gabapentin and pregabalin groups, overall morphine consumption, preoperative anxiety, pruritus, postoperative shivering were significantly lower (p-value less than 0.05 for all), and patient satisfaction was significantly higher than those in the placebo group (p-value less than 0.05).. This study showed that both pregabalin 300 mg day-1 and gabapentin 1,200 mg day-1 have more analgesic, anxiolytic and opioid-sparing effects, higher patient satisfaction and are more effective for preventing postoperative shivering than the placebo following lumbar laminectomy and discectomy. The findings revealed that pregabalin 300 mg day-1 had equivalent analgesic, adverse and opioid-sparing effects and patient satisfaction as gabapentin 1,200 mg day-1.

Topics: Adult; Aged; Amines; Analgesics; Anesthesiology; Cyclohexanecarboxylic Acids; Diskectomy; Double-Blind Method; Drug Administration Schedule; Female; Gabapentin; gamma-Aminobutyric Acid; Humans; Laminectomy; Lumbar Vertebrae; Male; Middle Aged; Morphine; Pain Measurement; Pain, Postoperative; Placebos; Pregabalin

The treatment of pain in obese patients is always a challenge. These patients have low pain thresholds, and the use of opioids can be especially harmful. Intraoperative nervous fiber section and the high temperatures of electrical scalpels probably contribute to the generation of postoperative neuropathic pain. We hypothesized that an antineuropathic pain drug like pregabalin could be helpful to optimize postoperative analgesia by reducing the requirement for opioids and their associated side effects.. Eighty adults undergoing laparoscopic sleeve gastrectomy were randomly assigned to orally receive either placebo capsules (control) or pregabalin (150 mg) 2 h before surgery. Postoperative morphine consumption during the first 24 postoperative hours was registered. Visual analog pain scores (VAS) were assessed at 1, 2, 4, 6, 8, 12, 16, and 24 h after surgery. Both the incidence of adverse reactions and patient satisfaction were also assessed.. Over a 24-h period, the morphine consumption in the pregabalin group was 11.51 ± 7.93 mg, whereas in the control group, it was 23.07 ± 9.57 mg (p < 0.0001). VAS scores were significantly lower in the pregabalin group. Postoperative nausea and vomiting and the consumption of antiemetics were reduced in the pregabalin group.. A single preoperative oral dose of 150 mg pregabalin is useful for reducing morphine consumption after a sleeve gastrectomy, and it guarantees effective and safe analgesia with a low incidence of adverse effects.

Topics: Adult; Aged; Analgesia; Analgesics; Analgesics, Opioid; Antiemetics; Double-Blind Method; Female; gamma-Aminobutyric Acid; Gastrectomy; Humans; Laparoscopy; Male; Middle Aged; Neuralgia; Obesity; Pain, Postoperative; Postoperative Nausea and Vomiting; Pregabalin; Preoperative Care; Young Adult

Despite the enormous success of total knee arthroplasty (TKA), chronic neuropathic pain can develop postoperatively and is both distressing and difficult to treat once established. We hypothesized that perioperative treatment with pregabalin, a chronic pain medication, would reduce the incidence of postsurgical neuropathic pain.. We performed a randomized, placebo-controlled, double-blind trial of pregabalin (300 mg) administered before TKA and for 14 days after TKA (150-50 mg twice daily). Patients were screened for the presence of neuropathic pain at 3 and 6 mo postoperatively using the Leeds Assessment of Neuropathic Symptoms and Signs scale. Secondary outcomes included postsurgical recovery and rehabilitation measures, including knee range of motion, opioid consumption, postoperative pain scores, sleep disturbance, and time to discharge as well as the occurrence of postoperative systemic complications.. Of the 240 patients randomly assigned to the 2 treatment groups (120 in each), data for the primary outcome were obtained from 113 pregabalin patients and 115 placebo patients. At both 3 and 6 mo postoperatively, the incidence of neuropathic pain was less frequent in the pregabalin group (0%) compared with the placebo group (8.7% and 5.2% at 3 and 6 mo, respectively; P = 0.001 and P = 0.014). Patients receiving pregabalin also consumed less epidural opioids (P = 0.003), required less oral opioid pain medication while hospitalized (P = 0.005), and had greater active flexion over the first 30 postoperative days (P = 0.013). There were no differences in the actual recorded duration of hospitalization between the 2 groups, although time to achieve hospital discharge criteria was longer for placebo patients, 69.0 +/- 16.0 h (mean +/- SD), than that of pregabalin patients, 60.2 +/- 15.8 h (P = 0.001). Sedation (P = 0.005) and confusion (P = 0.013) were more frequent on the day of surgery and postoperative day 1 in patients receiving pregabalin.. Perioperative pregabalin administration reduces the incidence of chronic neuropathic pain after TKA, with less opioid consumption and better range of motion during the first 30 days of rehabilitation. However, in the doses tested, it is associated with a higher risk of early postoperative sedation and confusion.

Topics: Aged; Analgesics; Anesthesia, Epidural; Arthroplasty, Replacement, Knee; Chronic Disease; Double-Blind Method; Female; gamma-Aminobutyric Acid; Humans; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Peripheral Nervous System Diseases; Pregabalin; Prospective Studies; Range of Motion, Articular; Sleep; Treatment Outcome

Patient outcome after lumbar discectomy for radicular low back pain is variable and the benefit is inconsistent. Many patients continue to experience pain 3 months after surgery. Pregabalin, a membrane stabilizer, may decrease perioperative central sensitization and subsequent persistent pain.. Forty patients undergoing lumbar discectomy were randomly allocated to receive either pregabalin (300 mg at 90 minutes preoperatively and 150 mg at 12 and 24 hours postoperatively) or placebo at corresponding times in a double-blinded manner. Our primary outcome was the change in the present pain intensity (PPI) (visual analog scale [VAS], 0-100 mm [PPI-VAS, McGill Pain Questionnaire]) from preoperatively to 3 months postoperatively.. The decrease in PPI-VAS score at 3 months was greater in patients who received pregabalin (37.6 +/- 19.6 mm) (mean +/- sd) than those who received placebo (25.3 +/- 21.9 mm) (P = 0.08). The Roland Morris disability score at 3 months was less in patients who received pregabalin (2.7 +/- 2.4) than in those who received placebo (5.6 +/- 4.8) (P = 0.032). Pregabalin administration was associated with greater pain tolerance thresholds in both lower limbs compared with placebo at 24 hours postoperatively.. Perioperative pregabalin administration is associated with less pain intensity and improved functional outcomes 3 months after lumbar discectomy.

Topics: Adolescent; Adult; Analgesics; Anesthesia; Diskectomy; DNA; Double-Blind Method; Electric Stimulation; Female; gamma-Aminobutyric Acid; Hemodynamics; Humans; Male; Middle Aged; Pain Measurement; Pain Threshold; Pain, Postoperative; Pregabalin; Receptors, Opioid, mu; Reverse Transcriptase Polymerase Chain Reaction; Treatment Outcome; Young Adult

Perioperative administration of pregabalin, which is effective for neuropathic pain, might reduce early postoperative and chronic pain. This randomized, double-blinded, placebo-controlled trial (Clinical Trials.gov ID NCT00905580) was designed to investigate the efficacy and safety of pregabalin for reducing both acute postoperative pain and the development of chronic pain in patients after robot-assisted endoscopic thyroidectomy.. Ninety-nine patients were randomly assigned to groups that received pregabalin 150 mg or placebo 1 h before surgery, with the dose repeated after 12 h. Assessments of pain and side effects were performed 48 h postoperatively. The incidences of chronic pain and hypoesthesia in the anterior chest were recorded 3 months after surgery.. Ninety-four patients completed the study. Verbal numerical rating scale scores for pain and the need for additional analgesics were lower in the pregabalin group (n = 47) than the placebo group (n = 47) during 48 h postoperatively (P < 0.05). However, incidences of sedation and dizziness were higher in the pregabalin group (P < 0.05). There were no differences between the groups in the incidences of chronic pain and chest hypoesthesia at 3 months after surgery.. Perioperative administration of pregabalin (150 mg twice per day) was effective in reducing early postoperative pain but not chronic pain in patients undergoing robot-assisted endoscopic thyroidectomy. Caution should be taken regarding dizziness and sedation.

Topics: Administration, Oral; Adult; Analgesics; Double-Blind Method; Endoscopy; Female; gamma-Aminobutyric Acid; Humans; Male; Middle Aged; Pain, Postoperative; Perioperative Care; Postoperative Nausea and Vomiting; Pregabalin; Robotics; Thyroid Neoplasms; Thyroidectomy; Young Adult

The objective of this study was to examine the effects of low-dose pregabalin on the analgesic efficacy, side-effects, and recovery profile in patients undergoing laparoscopic cholecystectomy.. One hundred and sixty-two patients aged 18-65 yr, of ASA physical status I-III, undergoing elective outpatient laparoscopic cholecystectomy were recruited and randomized in this prospective, placebo-controlled, double-blind study to receive one of the following study medications orally: pregabalin 50 mg, pregabalin 75 mg, or placebo, 1 h before surgery and then every 12 h after operation for a total of three doses. Postoperative numeric pain scores, analgesic consumption, recovery score (QoR-40), and side-effects (opioid-related symptom distress scale) were assessed in the early postoperative period (every 15 min during the first hour, at 90, 120 min, 6, and 12 h) and at days 1, 2, and 7. Data were analysed using an intention-to-treat method.. Compared with the placebo group, the pain scores were lower in the pregabalin 75 mg group in the first 90 min after surgery (P<0.05). Pregabalin 50 mg resulted in pain reduction at 30 and 45 min (P<0.05) relative to placebo. The analgesic consumption, side-effects, and recovery scores were similar among the three groups.. Perioperative administration of pregabalin 75 mg provided limited analgesic benefit in the postoperative period. An updated meta-analysis confirms this finding (see Supplementary material).

Topics: Adolescent; Adult; Aged; Ambulatory Surgical Procedures; Analgesics, Non-Narcotic; Analgesics, Opioid; Anesthesia, General; Cholecystectomy, Laparoscopic; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; gamma-Aminobutyric Acid; Humans; Middle Aged; Pain Measurement; Pain, Postoperative; Pregabalin; Premedication; Prospective Studies

bunionectomy has been used as a model of postoperative pain for opioids and nonsteroidal anti-inflammatory drugs/cyclooxygenase-2 inhibitors with a fast onset of analgesia. The present study was conducted to assess whether the utility of the model can be broadened in assessing the efficacy of analgesics with diverse mechanisms and pharmacokinetic profiles in drug development and to enhance the sensitivity of a bunionectomy model.. this was a single center, randomized, double-blind, placebo-controlled, three-arm, parallel group methodology study to evaluate the effects of pregabalin and naproxen sodium on postoperative pain following bunionectomy. Patients (n=100) were randomized 1:1:1 to three treatments (administered 1 hour before and at defined intervals after surgery): pregabalin 300 mg before surgery and 150 mg every 8 hours; naproxen sodium 550 mg before surgery and 550 mg every 12 hours; or placebo in a double-dummy fashion. Primary endpoints were patient-controlled analgesic (PCA) hydromorphone consumption and the time to first PCA hydromorphone use postsurgery over 24 hours.. of the 100 patients randomized, 96 completed the study. Relative to placebo, pregabalin and naproxen sodium, respectively, reduced PCA hydromorphone consumption by 51% (P=0.005) and 65% (P<0.001) and increased the median time to first use of PCA hydromorphone by 1.5 hours (P=0.004) and 3.7 hours (P<0.001). Both drugs significantly (P<0.050) decreased use of oral opioid rescue medication over 24-48 hours postsurgery relative to placebo. Although there were no statistically significant differences between naproxen sodium and pregabalin in opioid consumption and global evaluation of medication, overall naproxen sodium appeared to be more effective at reducing pain.. the model provided a sensitive method for evaluating efficacy of compounds with diverse mechanisms and pharmacokinetic profiles. The robustness of the enhanced pain model renders bunionectomy pain a valuable tool to assess novel analgesic compounds in small numbers of subjects early in drug development.

Topics: Adult; Aged; Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Cyclooxygenase 2 Inhibitors; Double-Blind Method; Drug Administration Schedule; Female; gamma-Aminobutyric Acid; Hallux Valgus; Humans; Male; Middle Aged; Naproxen; Pain Measurement; Pain, Postoperative; Pregabalin; Treatment Outcome

Multimodal analgesia may be important for optimal postoperative pain treatment and facilitation of early mobilization and recovery. We investigated the analgesic effect of pregabalin and dexamethasone in combination with paracetamol after abdominal hysterectomy.. One hundred and sixteen patients were randomly assigned to either group A (paracetamol+placebo x 2), group B (paracetamol+pregabalin+placebo) or group C (paracetamol+pregabalin+dexamethasone). According to randomization and preoperatively, patients received paracetamol 1000 mg, pregabalin 300 mg, dexamethasone 8 mg or placebo. General anaesthesia was performed. Postoperative pain treatment was paracetamol 1000 mg x 4 and patient-controlled intravenous morphine, 2.5 mg bolus. Nausea was treated with ondansetron. Morphine consumption, pain score (visual analogue scale) at rest and during mobilization, nausea, sedation, dizziness, number of vomits and consumption of ondansetron were recorded 2, 4 and 24 h after the operation. P<0.05 was considered statistically significant.. The 24-h morphine consumption and pain score, both at rest and during mobilization, were not significantly different between treatment groups. The mean nausea score (P=0.002) was reduced in group C vs. A. The number of vomits was significantly reduced in both group B (P=0.041) and C (P=0.001) vs. A. Consumption of ondansetron was reduced in group C vs. A and B (P<0.001). Other side effects were not different between groups.. Combinations of paracetamol and pregabalin, or paracetamol, pregabalin and dexamethasone did not reduce morphine consumption and pain score compared with paracetamol alone for patients undergoing abdominal hysterectomy. Dexamethasone reduced nausea, vomiting and use of ondansetron.

Topics: Acetaminophen; Adolescent; Adult; Aged; Analgesics, Non-Narcotic; Antiemetics; Dexamethasone; Double-Blind Method; Drug Therapy, Combination; Female; gamma-Aminobutyric Acid; Humans; Hysterectomy; Middle Aged; Morphine; Ondansetron; Pain Measurement; Pain, Postoperative; Postoperative Nausea and Vomiting; Pregabalin; Prospective Studies; Young Adult

Pregabalin is a gabapentinoid compound, which has been alleged to possess anxiolytic, analgesic, and anticonvulsant properties. We hypothesized that premedication with oral pregabalin would produce dose-related reductions in acute (state) anxiety and increases in sedation (sleepiness) before induction of general anesthesia. A secondary objective was to determine if premedication with pregabalin would reduce postoperative pain.. One hundred eight ASA I-III outpatients undergoing elective surgery were randomly assigned to one of the four premedication treatment groups: 1) control group received placebo capsules, 2) pregabalin 75 group received pregabalin 75 mg, po, 3) pregabalin 150 group received pregabalin 150 mg, po, and 4) pregabalin 300 group received pregabalin 300 mg, po. The effects of the study drug on the patients' level of anxiety, sedation, and pain were assessed at baseline (immediately before study drug administration), at 30 and 60 min after drug administration, and immediately before induction of anesthesia, as well as at 30-min intervals in the postanesthesia care unit (PACU) using standardized 11-point verbal rating scales, with 0 = none to 10 = maximal effect. The need for postoperative opioid analgesic medication, incidence of nausea and vomiting, requirement for rescue antiemetics, and times to discharge from the PACU and hospital, as well as the patients' quality of recovery scores, and late recovery outcomes (e.g., resumption of dietary intake and recovery of bowel function) were assessed at a 7-day follow-up interview.. Demographic characteristics, times between study drug administration to anesthetic induction, type of surgical procedures, duration of anesthesia, PACU and hospital discharge time, as well as the requirement for fentanyl in the PACU, did not differ among the four study groups. Anxiety levels remained unchanged during the preoperative evaluation period, and did not differ among the four study groups. Sedation scores were significantly higher in the pregabalin 300 group at the preinduction assessment interval and at 90 and 120 min after surgery compared with the control group (5 +/- 3 vs 3 +/- 2, 7 +/- 4 vs 5 +/- 3, 8 +/- 4 vs 4 +/- 4, respectively, P < 0.05).. Preoperative pregabalin administration (75-300 mg po) increased perioperative sedation in a dose-related fashion, but failed to reduce preoperative state anxiety, postoperative pain, or to improve the recovery process after minor elective surgery procedures.

Topics: Administration, Oral; Adult; Analgesics; Analgesics, Opioid; Anti-Anxiety Agents; Antiemetics; Anxiety; Capsules; Dose-Response Relationship, Drug; Double-Blind Method; Elective Surgical Procedures; Female; Fentanyl; gamma-Aminobutyric Acid; Humans; Hypnotics and Sedatives; Length of Stay; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Postoperative Nausea and Vomiting; Preanesthetic Medication; Pregabalin; Recovery of Function; Sleep; Time Factors

Postlaparoscopic shoulder pain (PLSP) frequently follows laparoscopic surgery. In this placebo-controlled study, we evaluated the efficacy of two perioperative doses of pregabalin 300 mg 12 h apart for preventing and attenuating PLSP after laparoscopic cholecystectomy. The frequency and severity of PLSP, need for postoperative rescue analgesia, and side effect profiles were assessed for 48 h postoperatively. In both groups, the overall incidence of PLSP did not differ significantly, and the pain score for PLSP, time to first rescue analgesia, and cumulative ketorolac consumption were similar at each timepoint. However, the 2-h postoperative incidence of oversedation was higher with pregabalin.

Topics: Adult; Analgesics; Cholecystectomy, Laparoscopic; Double-Blind Method; Drug Administration Schedule; gamma-Aminobutyric Acid; Humans; Ketorolac; Pain Measurement; Pain, Postoperative; Pregabalin; Prospective Studies; Severity of Illness Index; Shoulder Pain; Sleep; Time Factors

Achieving post operative pain management is difficult with the use of only opioids analgesia. Multimodal pain management is a method to improve post operative analgesia with minimal side effects. Pregabalin has an analgesic and opioids sparing effects in post operative analgesia.. The objective of the present study was to evaluate the effect of premedication with pregabalin 300 mg compared with lorazepam 0.5 mg on post operative morphine consumption in women undergoing abdominal hysterectomy with/without salphingo-oophorectomy.. Eighty ASA I-III, aged 18-65 year patients undergoing elective abdominal hysterectomy with/without salphingo-oophorectomy were randomized to receive either lorazepam 0.5 mg or pregabalin 300 mg 1 hr before surgery. Anesthesia was induced with thiopental (3-5 mg/kg) and atracurium (0.6 mg/kg) and maintained with sevoflurane with a fresh gas flow of 2 L/min (50% N2O in O2) and morphine 0.1-0.2 mg/kg. All patients received patient-controlled analgesia with morphine with a 1 mg incremental dose, 5-min lockout interval, and 4-hr limit of 40 mg post operative. Patients were studied at 0, 1, 4, 12 and 24 hours post operatively for verbal numerical rating scale (VNRS), morphine consumption, satisfaction score and side effects.. The VNRS scores of the pregabalin group were significantly lower than the control group at 1, 4, 12 and 24 hours after surgery. The total morphine consumption at 24 hours post operatively of pregabalin group (7.11 +/- 5.57) was significantly lower than the control group (21.18 +/- 7.12) (p < 0.01). There were no differences between groups in somnolence and dizziness (p = 0.93) and nausea-vomiting (p = 0.11). The satisfaction score was higher in the pregabalin group.. A 300 mg pregabalin administered 1 hr preoperatively before abdominal hysterectomy with/without salphingo-oophorectomy significantly reduced morphine consumption, VNRS pain score and improved satisfaction score at 24 hr post operatively without any significant differences in side effects. Pregabalin is an alternative combination to opioids as multimodal analgesia.

Topics: Analgesics; Analgesics, Opioid; Double-Blind Method; Fallopian Tubes; Female; gamma-Aminobutyric Acid; Humans; Hysterectomy; Morphine; Ovariectomy; Pain Measurement; Pain, Postoperative; Pregabalin; Premedication

Optimal pain treatment with minimal side-effects is essential for early mobility and recovery in patients undergoing total hip arthroplasty. We investigated the analgesic effect of pregabalin and dexamethasone in this surgical procedure.. One hundred and twenty patients were randomly allocated to either Group A (placebo), Group B (pregabalin 300 mg), or Group C (pregabalin 300 mg+dexamethasone 8 mg). The medication and acetaminophen 1 g were given before operation. Spinal anaesthesia was performed. Postoperative pain treatment was with acetaminophen 1 g three times daily and patient-controlled i.v morphine, 2.5 mg bolus. Nausea was treated with ondansetron. Morphine consumption, pain intensity at rest and during mobilization, nausea and vomiting, sedation, dizziness, and consumption of ondansetron were recorded 2, 4, and 24 h after operation. P<0.05 was considered statistically significant.. Twenty-four hour morphine consumption was significantly reduced in Groups B [mean (SD) 24 (14) mg] and C [25 (19) mg] compared with Group A [47 (28) mg]. Vomiting was reduced in Group C compared with Group B (P=0.03). Sedation was significantly increased in Group B compared with the other groups.. Pregabalin resulted in a 50% reduction in 24 h postoperative morphine requirements. This was not associated with a reduced incidence of nausea or vomiting. Pregabalin resulted in increased levels of sedation. Combining pregabalin and dexamethasone provided no additional effects on pain or opioid requirements.

Topics: Aged; Analgesics, Non-Narcotic; Analgesics, Opioid; Arthroplasty, Replacement, Hip; Consciousness; Dexamethasone; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Female; gamma-Aminobutyric Acid; Humans; Male; Middle Aged; Morphine; Pain Measurement; Pain, Postoperative; Postoperative Nausea and Vomiting; Pregabalin; Prospective Studies

Postoperative pain is the dominating complaint and the primary reason for prolonged convalescence after laparoscopic cholecystectomy. We have evaluated the efficacy of a single preoperative dose of pregabalin for attenuating postoperative pain and fentanyl consumption after laparoscopic cholecystectomy.. Sixty adults (16-60 yr), ASA physical status I and II, of either sex undergoing elective laparoscopic cholecystectomy were included in this prospective, randomized placebo controlled, double-blind study. Subjects were divided into two groups of 30 each to receive either a matching placebo or pregabalin 150 mg, administered orally 1 h before surgery. Postoperative pain (static and dynamic) was assessed by a 100 mm visual analogue scale, where 0, no pain; 100, worst imaginable pain. Subjects received patient-controlled i.v. fentanyl analgesia during the postoperative period. Results were analysed by Student's t-test, chi(2) test, Mann-Whitney U-test, and Fisher's exact test.. Postoperative pain (static and dynamic) and postoperative patient-controlled fentanyl consumption were reduced in the pregabalin group compared with the placebo group (P<0.05). Side-effects were similar in both groups.. A single preoperative oral dose of pregabalin 150 mg is an effective method for reducing postoperative pain and fentanyl consumption in patients undergoing laparoscopic cholecystectomy.

Topics: Administration, Oral; Adolescent; Adult; Analgesics, Non-Narcotic; Analgesics, Opioid; Cholecystectomy, Laparoscopic; Double-Blind Method; Drug Administration Schedule; Female; Fentanyl; gamma-Aminobutyric Acid; Humans; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Preanesthetic Medication; Pregabalin; Prospective Studies

Pregabalin has anticonvulsant, antihyperalgesic, and anxiolytic properties. In this study we evaluated the control of pain after perioperative administration of pregabalin 300 or 600 mg, compared with diazepam 10mg. Altogether 91 women scheduled for laparoscopic hysterectomy were randomized to receive diazepam 10mg (D10), pregabalin 150 mg (P300) or 300 mg (P600) for premedication, and the dose was repeated after 12h, except for the D10 group, in which the patients received placebo. Up until the 1st postoperative morning, analgesia was provided by oxycodone using patient controlled analgesia. The visual analogue scale scores for pain and side effects, and the amounts of the analgesics were recorded for three days after surgery. The doses of oxycodone during hours 0-12 after surgery were similar in the three groups, whereas the dose of oxycodone during hours 12-24 after surgery was smaller in the P600 group than in the P300 group (0.09 vs. 0.16 mg kg(-1); P=0.025). The total dose of oxycodone (0-24h after surgery) was smaller in the P600 group than in the D10 group (0.34 vs. 0.45 mg kg(-1); P=0.046). The incidence of dizziness (70% vs. 35%; P=0.012), blurred vision (63% vs. 14%; P=0.002) and headache (31% vs. 7%; P=0.041) were higher in the P600 group than in the D10 group. In conclusion, perioperative administration of pregabalin 600 mg decreases oxycodone consumption compared with diazepam 10mg, but is associated with an increased incidence of adverse effects.

Topics: Adult; Drug Administration Schedule; Female; gamma-Aminobutyric Acid; Humans; Hysterectomy; Laparoscopy; Middle Aged; Oxycodone; Pain, Postoperative; Perioperative Care; Pregabalin

Multimodal pain management has been suggested to improve postoperative analgesia. In this study, we evaluated the quality of analgesia in women undergoing day-case gynaecological laparoscopic surgery, after premedication with pregabalin 75 mg (P75) or 150 mg (P150), compared with diazepam 5 mg (D5). All patients were given ibuprofen 800 mg orally.. Altogether 90 consenting women were anaesthetized in a standardized fashion. Postoperative analgesia was provided by ibuprofen 800 mg twice a day with fentanyl i.v. on request in the recovery room (RR), and combination tablets with acetaminophen and codeine after the RR. The visual analogue scale (VAS) scores for pain and side-effects and the amounts of postoperative analgesics were recorded for 24 h after surgery. The areas under the curves (AUC) were calculated for the VAS scores for pain at rest, pain in motion, and pain at cough 1-8 and 1-24 h after surgery.. The median AUC values for VAS scores for pain at rest (P=0.048) and in motion (P=0.046) 1-8 h after surgery were lower in the P150 group than that in the D5 group. The amounts of rescue analgesics or the degree of drowsiness did not differ in the three study groups.. Analgesia was better after premedication with pregabalin 150 mg than after diazepam 5 mg, both with ibuprofen 800 mg, during the early recovery after day-case gynaecological laparoscopic surgery. Pregabalin 150 mg did not reduce the amount of postoperative analgesics required.

Topics: Adult; Ambulatory Surgical Procedures; Analgesics; Dose-Response Relationship, Drug; Double-Blind Method; Drug Therapy, Combination; Female; gamma-Aminobutyric Acid; Gynecologic Surgical Procedures; Humans; Ibuprofen; Laparoscopy; Middle Aged; Pain, Postoperative; Patient Satisfaction; Pregabalin; Premedication

Although pregabalin shows efficacy against neuropathic pain, very limited evidence supports postoperative analgesic efficacy. Our study objective was to investigate analgesic efficacy in an ambulatory day surgical population experiencing acute visceral pain. The null hypothesis was that there was no significant difference in pain relief between pregabalin and placebo.. A randomized, double-blind, parallel-group, placebo-controlled trial was performed in 90 women having minor gynecological surgery involving the uterus. Patients received either oral pregabalin 100 mg (Group PG) or placebo (Group C) approximately 1 h before surgery. The primary outcome was pain score in the recovery unit and patients were followed for 24 h.. There was no significant difference between groups for pain experienced in the recovery room (median, interquartile range 16, 0-36 vs 10, 6.5-36 for Groups PG and C, respectively, P = 0.80) or thereafter; nor for recovery room fentanyl requirement (42% Group PG versus 27% Group C, P = 0.12) or the quality of recovery at 24 h postoperatively (median, interquartile range score 17, 17-18 Group PG versus 18, 16.5-18 Group C, P = 0.75). The incidence of posthospital discharge light-headedness, visual disturbance, and difficulty with walking was significantly higher in the pregabalin group.. A single preoperative dose of 100 mg pregabalin does not reduce acute pain or improve recovery after minor surgery involving only the uterus.

Topics: Administration, Oral; Adult; Double-Blind Method; Female; gamma-Aminobutyric Acid; Gynecologic Surgical Procedures; Headache; Humans; Middle Aged; Pain Measurement; Pain, Postoperative; Pregabalin; Preoperative Care

As optimal pain relief after surgery is difficult to achieve with the use of just one drug, many pain experts advocate the use of two or more classes of medications so as to reduce the side effects from any one drug. In this trial, we assessed the analgesic efficacy of administering perioperative celecoxib, pregabalin, or both after spinal fusion surgery.. Eighty patients scheduled to undergo elective decompressive lumbar laminectomy with posterior spinal fusion were randomized to receive oral medications: placebo 1 h before and 12 h after surgery, celecoxib 400 mg 1 h before and celecoxib 200 mg 12 h after surgery, pregabalin 150 mg 1 h before and 12 h after surgery, or a pregabalin/celecoxib combination of 400 mg/150 mg 1 h before and 200 mg/150 mg 12 h after surgery.. The pregabalin/celecoxib group consumed the least patient-controlled morphine. Celecoxib alone or pregabalin alone also reduced opioid use compared with placebo, but not as much as when combined. The pregabalin/celecoxib combination was the most effective treatment for reducing pain both at rest and with movement over the 24-h postoperative time period. Hemodynamics and respiratory rate did not differ among the four treatment groups. Fewer patients experienced nausea in the pregabalin/celecoxib group compared with that in the placebo group.. The perioperative administration of the combination of celecoxib and pregabalin improved analgesia and caused fewer side effects, than either analgesic drug alone after spinal fusion surgery.

Topics: Adult; Analgesia, Patient-Controlled; Analgesics; Celecoxib; Dose-Response Relationship, Drug; Double-Blind Method; Drug Therapy, Combination; Female; gamma-Aminobutyric Acid; Humans; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Pregabalin; Prospective Studies; Pyrazoles; Spinal Fusion; Sulfonamides

Pregabalin is an analogue of the inhibitory neurotransmitter gamma-aminobutyric acid. In preclinical models, it has shown activity as an analgesic agent. A randomized, double-blind, placebo-controlled, parallel-group trial was undertaken to compare pregabalin to placebo and 400 mg of ibuprofen using a dental pain model. Study medication was administered postoperatively to patients who had undergone elective surgery to remove one or two third molars, at least one of which was mandibular and fully or partially impacted in bone. The study was conducted in the UK at a single centre and evaluated pregabalin at doses of 50 and 300 mg. Primary efficacy parameters included pain relief (PR), pain intensity difference (PID), pain relief intensity difference (PRID), time to onset of analgesia, and duration of analgesia. The patient's global impression of the study medication was used as a secondary efficacy parameter. Efficacy data were evaluated for the intent-to-treat (ITT) population, defined as all randomized patients who took study medication. Results showed that there were statistically significant differences in PR, PID, and PRID between the 300-mg pregabalin group and placebo. In addition, the 300-mg pregabalin group had a significantly longer duration of analgesia than the ibuprofen group and had the highest score on the patient global impression of study medication. Adverse events were reported more frequently in the pregabalin 300-mg group. Pregabalin appears to have significant analgesic properties in the third molar extraction model. Further research is needed to confirm these findings.

Topics: Adolescent; Adult; Analgesics, Non-Narcotic; Anesthesia, Local; Anticonvulsants; Double-Blind Method; Female; gamma-Aminobutyric Acid; Humans; Ibuprofen; Male; Middle Aged; Pain, Postoperative; Pregabalin; Tooth Extraction; Tooth, Impacted

In France, prescribing pregabalin requires a secure prescription valid for 6 months since the decree of 12 February 2021, based on recommendations of the French Centre for Evaluation and Information on Pharmacodependence and Addiction vigilance (CEIP-A). This led to discontinuation of this treatment as a postoperative analgesic in the French ACL Study (FAST) cohort. We aimed to evaluate the impact of this change on early postoperative pain.. Pregabalin is an important analgesic for reducing early postoperative pain after anterior cruciate ligament (ACL) repair.. At our healthcare facility, 584 patients from the FAST cohort who underwent primary isolated ACL reconstruction were included: 292 patients operated before June 1, 2021 who received pregabalin postoperatively and 292 patients operated after June 1, 2021 who did not receive pregabalin. The patients were matched based on age, sex, preoperative Lysholm and Tegner scores. Pain was evaluated on a visual analog scale (VAS) on D0 in the evening, D0 at night, D1, D2 and D3.. The patients who did not receive pregabalin had more severe pain at night on D0: 5.21 vs 5.68 (p=.048). There was no difference between groups in the postoperative pain at rest during the evening of D0 (p=.89), D1 (p=.33), D2 (p=.37) and D3 (p=.21).. In the context of outpatient arthroscopic ACL reconstruction, pregabalin does not reduce early postoperative pain in a clinically significant manner.. IV; case-control study.

Topics: Analgesics; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Case-Control Studies; Humans; Outpatients; Pain, Postoperative; Pregabalin; Treatment Outcome

The American Academy of Orthopaedic Surgeons Clinical Practice Guideline "Pharmacologic, Physical, and Cognitive Pain Alleviation for Musculoskeletal Extremity/Pelvis Surgery" is a summary of the available literature designed to help guide surgeons provide a safe and effective means of pain alleviation for orthopaedic surgery patients. The following case study demonstrates these guidelines at work in a patient undergoing total shoulder arthroplasty. The recommendations listed in the following sentences are from the Clinical Practice Guideline. Preoperative patient education regarding the effects of opioids and benefits of early termination may help patients discontinue opioids earlier in their postoperative course. Perioperative use of intravenous ketamine and regional anesthesia continuous peripheral nerve catheters help reduce pain scores and decrease opioid use. Postoperative cryotherapy may provide a modest benefit in reducing pain scores. Postoperative cyclooxygenase-2 selective nonsteroidal anti-inflammatory medications (NSAIDs) and oral acetaminophen improve pain and decrease opioid use. Combination opioid/NSAIDs may provide a modest improvement in pain scores at the expense of NSAID dose optimization in the postoperative period. Gabapentin has not been shown to improve patient outcomes; however, pregabalin may decrease pain and opioid use after total joint arthroplasty.

Topics: Acetaminophen; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Cognition; Cyclooxygenase 2; Extremities; Gabapentin; Humans; Ketamine; Orthopedic Procedures; Pain Measurement; Pain, Postoperative; Pelvis; Pregabalin

Topics: Acetaminophen; Aged; Analgesics; Anesthesia, Local; Anesthetics, Local; Breakthrough Pain; Celecoxib; Epinephrine; Humans; Lidocaine; Mohs Surgery; Oxycodone; Pain Management; Pain, Postoperative; Pregabalin; Ropivacaine; Vasoconstrictor Agents

Pain management is a major component of postoperative patient care. Pain management following total knee arthroplasty (TKA) provides patient comfort and early mobilization and prevents serious complications. The present study aimed to evaluate the effects of preoperative administration of oral pregabalin on postoperative pain control in patients undergoing TKA.. One hundred and twenty-six patients undergoing TKA were retrospectively included, of whom 65 (51.6%) received 150 mg pregabalin 2 hours before the operation and 61 (48.4%) did not. All patients received the same postoperative pain management protocol. Resting pain was recorded using a visual analog scale (VAS) at the postoperative 4th, 12th, and 48th hours. Findings including headache, dizziness, nausea-vomiting, constipation, dry mouth, pruritus, urinary retention, and sleepiness were recorded.. The mean age of 126 patients (84.1% female) was 65.5 ± 4.5 years (range, 55-72 years). No significant differences were found in age, sex, ASA score, and operation duration between the groups. VAS scores at the postoperative 4th, 12th, and 48th hours, frequency of pushing the button of PCA system, and the total tramadol dose were significantly lower in the pregabalin group. The percent decrease in the postoperative VAS scores from the 4th hour to the 48th hour was significant in the pregabalin group. Nausea was the most frequent side effect followed by urinary retention, constipation, and pruritus.. Preoperative pregabalin administration provided a favorable contribution to the postoperative pain management in the patients undergoing TKA. Preoperative pregabalin administration could reduce opioid drug usage and opioid related side effects.

Topics: Aged; Analgesics; Arthroplasty, Replacement, Knee; Female; Humans; Male; Middle Aged; Pain, Postoperative; Pregabalin; Retrospective Studies

Considering the adverse effects of opioids, it is essential to minimize their consumption for postoperative pain control. Studies have reported the opioid sparing effects of pregabalin, with conflicting results. Evidence for administering pregabalin in a multimodal regimen after arthroscopic rotator cuff repair surgery is limited.. A total of 64 patients who underwent arthroscopic rotator cuff repair were enrolled in the cohort, and their data were retrospectively analyzed to evaluate the ability of pregabalin for postoperative analgesia and opioid sparing. The pregabalin group (n = 32) received additional pregabalin 75 mg for 2 weeks from the day before the surgery with the standard pain medications; in contrast, the control group (n = 32) was prescribed the standard pain medications alone. The total volume of patient-controlled anesthesia, doses of oral oxycodone and intravenous morphine as rescue analgesics, number of adverse events, and patient satisfaction based on the numeric rating scale (0-10) were assessed. Further, we used the visual analog scale for evaluating pain and function for 6 months in each group.. Total patient-controlled anesthesia volume, number of patient-controlled anesthesia attempts on the day of surgery, and total oral oxycodone consumption were significantly lower in the pregabalin group. Visual analog scale scores for pain and function showed no significant differences. Although the total number of adverse effects (nausea, vomiting, dizziness, dry mouth, urinary retention, itching sense, or constipation) was higher in the pregabalin group than in the control group, the difference was not statistically significant.. Our multimodal regimen with pregabalin significantly reduced opioid consumption with similar adverse effects. However, there was no significant difference in the pain score. We recommend pregabalin as an additional analgesic for arthroscopic rotator cuff repairs, especially for medium to large sized tears.

Topics: Analgesics; Analgesics, Opioid; Arthroscopy; Humans; Pain, Postoperative; Pregabalin; Retrospective Studies; Rotator Cuff; Rotator Cuff Injuries

Previous findings indicate that pre-emptive pregabalin as part of multimodal anesthesia reduces opioid requirements compared to conventional anesthesia in patients undergoing robot-assisted laparoscopic prostatectomy (RALP). However, recent studies show contradictory evidence suggesting that pregabalin does not reduce postoperative pain or opioid consumption after surgeries. We conducted a register-based analysis on RALP patients treated over a 5-year period to evaluate postoperative opioid consumption between two multimodal anesthesia protocols.. We retrospectively evaluated patients undergoing RALP between years 2015 and 2019. Patients with American Society of Anesthesiologists status 1-3, age between 30 and 80 years and treated with standard multimodal anesthesia were included in the study. Pregabalin (PG) group received 150 mg of oral pregabalin as premedication before anesthesia induction, while the control (CTRL) group was treated conventionally. Postoperative opioid requirements were calculated as intravenous morphine equivalent doses for both groups. The impact of pregabalin on postoperative nausea and vomiting (PONV), and length of stay (LOS) was evaluated.. We included 245 patients in the PG group and 103 in the CTRL group. Median (IQR) opioid consumption over 24 postoperative hours was 15 (8-24) and 17 (8-25) mg in PG and CTRL groups (p = 0.44). We found no difference in postoperative opioid requirement between the two groups in post anesthesia care unit, or within 12 h postoperatively (p = 0.16; p = 0.09). The length of post anesthesia care unit stay was same in each group and there was no difference in PONV Similarly, median postoperative LOS was 31 h in both groups.. Patients undergoing RALP and receiving multimodal analgesia do not need significant amount of opioids postoperatively and can be discharged soon after the procedure. Pre-emptive administration of oral pregabalin does not reduce postoperative opioid consumption, PONV or LOS in these patients.

Topics: Adult; Aged; Aged, 80 and over; Analgesics; Analgesics, Opioid; Humans; Laparoscopy; Male; Middle Aged; Pain, Postoperative; Pregabalin; Premedication; Prostatectomy; Retrospective Studies; Robotic Surgical Procedures

Topics: Fasciculation; Humans; Myalgia; Pain, Postoperative; Pregabalin; Succinylcholine

Multimodal pain management strategies including pregabalin (PGB) have been shown to reduce pain and opioid use after many types of surgeries. This was a single-center, retrospective study aimed to determine whether a single pre-operative dose of PGB reduces opioid requirements and post-operative pain after orthotopic liver transplantation (OLT). Outcomes included the mean morphine milligram equivalents used; the proportion of patients with no pain documented; and the maximum level of pain documented within the first 24h and in the 24-72h following OLT. A total of 44 patients received PGB vs 57 who received standard of care. Baseline demographics were comparable between groups. Patients who received PGB required 70% and 54% less opioids within the first 24h and subsequent 24-72h post-OLT, respectively (p-values < .001). In the first 24h post-OLT, there were more patients with no documented pain, and fewer with severe pain in the PGB group, but these were not significant. A greater proportion in the PGB group reported a maximum of mild pain (p = .039). This study demonstrated that a single dose of pre-operative PGB significantly reduced opioid use in the first 72 h after OLT. Larger studies will help determine the safety and efficacy of PGB in this setting.

Topics: Analgesics; Analgesics, Opioid; Humans; Liver Transplantation; Pain, Postoperative; Pregabalin; Retrospective Studies

Although being controversial, pregabalin (PGB) is proposed during a short perioperative period  to improve pain relief.Comparisons between chronic and short-term users during lumbar spine surgery are lacking.. The purpose was to compare opioid requirements and postoperative pain among PGB chronic users and naive patients receiving a 48-hour perioperative administration.. Prospective nonrandomized study.. Tertiary care hospital.. Chronic users (group PGB, n = 39) continued their treatment, naive patients (group C, n = 43) received a dose of 150 mg preoperatively and 75 mg/12 hours for 48 hours. Anesthesia and analgesia were standardized. The primary outcome was the cumulative oxycodone consumption at 24 hours, other outcomes included pain scores, DN4 (Douleur Neuropathique 4 Questions) scores, and side effects.. Group PGB consumed less oxycodone at 24 hours (median [interquartile range] 10 mg [10-17.5] vs. 20 mg [10-20], P = 0.013], at 48 hours (15 mg [10-20] vs. 20 mg [12.5-30], P = 0.018), and required less intraoperative remifentanil (P = 0.004). Both groups showed similar pain scores during the 48-hour follow-up and at 3 months.Based on multivariate analysis, chronic users of PGB before surgery exhibited lower oxycodone requirements at 24 hours (odds ratio, 3.98; 95% confidence interval, 1.44-7.74; P = 0.008]. No differences were noted regarding side effects and DN4 scores.. Nonrandomized study.. Patients chronically treated with PGB required less opioid when compared with a short perioperative administration before spinal surgery. Further prospective studies are required to confirm these results in spinal surgeries.

Topics: Analgesics; Analgesics, Opioid; Double-Blind Method; Humans; Oxycodone; Pain Measurement; Pain, Postoperative; Pregabalin; Prospective Studies; Treatment Outcome

Topics: Cardiac Surgical Procedures; Humans; Ketamine; Pain, Postoperative; Pregabalin

Topics: Cardiac Surgical Procedures; Humans; Ketamine; Pain, Postoperative; Pregabalin

Topics: Analgesics; Ataxia; Dizziness; Gabapentin; Humans; Pain, Postoperative; Pregabalin; Preoperative Care

Widely used for acute pain management, the clinical benefit from perioperative use of gabapentinoids is uncertain. The aim of this systematic review was to assess the analgesic effect and adverse events with the perioperative use of gabapentinoids in adult patients.. Randomized controlled trials studying the use of gabapentinoids in adult patients undergoing surgery were included. The primary outcome was the intensity of postoperative acute pain. Secondary outcomes included the intensity of postoperative subacute pain, incidence of postoperative chronic pain, cumulative opioid use, persistent opioid use, lengths of stay, and adverse events. The clinical significance of the summary estimates was assessed based on established thresholds for minimally important differences.. In total, 281 trials (N = 24,682 participants) were included in this meta-analysis. Compared with controls, gabapentinoids were associated with a lower postoperative pain intensity (100-point scale) at 6 h (mean difference, -10; 95% CI, -12 to -9), 12 h (mean difference, -9; 95% CI, -10 to -7), 24 h (mean difference, -7; 95% CI, -8 to -6), and 48 h (mean difference, -3; 95% CI, -5 to -1). This effect was not clinically significant ranging below the minimally important difference (10 points out of 100) for each time point. These results were consistent regardless of the type of drug (gabapentin or pregabalin). No effect was observed on pain intensity at 72 h, subacute and chronic pain. The use of gabapentinoids was associated with a lower risk of postoperative nausea and vomiting but with more dizziness and visual disturbance.. No clinically significant analgesic effect for the perioperative use of gabapentinoids was observed. There was also no effect on the prevention of postoperative chronic pain and a greater risk of adverse events. These results do not support the routine use of pregabalin or gabapentin for the management of postoperative pain in adult patients.

Topics: Acute Pain; Adult; Analgesics; Gabapentin; Humans; Pain, Postoperative; Pregabalin

Topics: Anxiety; Humans; Oral Surgical Procedures; Pain, Postoperative; Pregabalin; Uncertainty

Opioids are commonly used for the management of postoperative pain, but their use is limited by important adverse events, such as respiratory depression and the potential for addiction. Multimodal opioid-sparing analgesia regimens can be effectively employed to manage postoperative pain and reduce exposure to opioids. Gabapentinoids (pregabalin and gabapentin) represent an attractive class of drugs for use in multimodal regimens. The American Pain Society recommends the use of gabapentinoids during the perioperative period; however, evidence to inform such a recommendation is unclear.. We will conduct a systematic review and meta-analysis of randomized clinical trials evaluating the use of systemic gabapentinoids, in comparison to other analgesic regimens or placebo in adult patients undergoing surgery. We will search MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), the Web of Science, and ClinicalTrials.gov databases for relevant citations. Our primary outcome will be intensity of postoperative acute pain (12 h). Our secondary outcomes will be postoperative pain intensity at 6, 24, 48 h, and 72 h, cumulative dose of opioids administered within 24, 48, and 72 h following surgery, the length of stay, chronic pain, and adverse events. Two investigators will independently select trials and extract data. We will evaluate the risk of bias of included trials using the Cochrane risk of bias tools. We will represent pooled continuous data as weighted mean differences and pooled dichotomous data as risk ratios with a 95% confidence interval. We will use random effect models and assess statistical heterogeneity with the I. Our study will provide the best level of evidence to inform the effect of gabapentinoids in the management of postoperative acute pain.. PROSPERO CRD42017067029.

Topics: Acute Pain; Analgesics; Gabapentin; Humans; Meta-Analysis as Topic; Pain, Postoperative; Perioperative Care; Pregabalin; Randomized Controlled Trials as Topic; Research Design; Risk Assessment; Systematic Reviews as Topic

Postmastectomy chronic pain (PMCP) is one of the important survivorship issues faced by breast cancer patients. It is a chronic pain which persists for more than 3 months after mastectomy or quadrantectomy and is considered to be neuropathic in nature. An open label, single-arm, prospective study was conducted to evaluate the efficacy of Pregabalin in relieving clinically significant PMCP (pain score ≥3 on visual analogue scale). Pregabalin brought about significant reductions in pain (visual analogue scale [VAS] Scores; baseline 5.50 ± 1.197, end of 1 month 2.40 ± 1.430, end of 2 months 2.10 ± 1.370) and significant improvement in quality of life.

Topics: Adult; Analgesics; Breast Neoplasms; Chronic Pain; Female; Humans; Mastectomy; Middle Aged; Pain Management; Pain, Postoperative; Pregabalin; Prospective Studies; Quality of Life

Gabapentinoids have governmental health agency approval for "chronic neuropathic pain." Over the last decade, however, the perioperative prescription of gabapentinoids has become more popular among anaesthesiologists due to their anxiolytic and antihyperalgesic proprieties, despite weak scientific evidence supporting the risk/benefit ratio for this indication.. Our aim was to extensively describe the use of perioperative gabapentinoids by French anaesthesiologists. An online questionnaire was sent to the French Society of Anaesthesiology members. The questionnaire, focusing on gabapentinoid prescriptions, included questions on demographic data, patient conditions and types of surgeries, mode of prescription, motives and presumed side effects (dizziness, confusion, desaturation and visual disorders).. Five hundred and eight questionnaires were analysed, among which 70% reported gabapentinoid use. Twenty-five percent of prescribers stated using gabapentinoids in all types of surgeries, 30% in outpatient surgeries and 46% in combination with regional anaesthesia. In 66% of the cases, preoperative and postoperative prescriptions were combined. Sedation, dizziness and visual disturbance were expected side effects according to 68%, 45% and 20% of anaesthesiologists, respectively. Reported reasons in favor of gabapentinoid prescription were prevention of chronic pain (93%), expected high postoperative acute pain, i.e. painful surgeries (91%), a history of chronic pain (72%) and patient opioid dependence (72%).. French anaesthesiologists have recently included gabapentinoids in the multimodal management of postoperative pain but they are unaware of certain frequent side effects. Moreover, their expectations about the prevention of chronic pain are not validated. Our survey is a call to moderate the systematic prescription of these drugs in the perioperative period.

Topics: Anesthesia; Drug Prescriptions; Drug Utilization; Evidence-Based Medicine; Excitatory Amino Acid Antagonists; France; Gabapentin; Health Care Surveys; Humans; Pain Management; Pain Measurement; Pain, Postoperative; Perioperative Care; Pregabalin; Surveys and Questionnaires

Topics: Acute Pain; Analgesics, Opioid; Humans; Morphine; Pain, Postoperative; Pregabalin

We performed a multicenter observational study to assess the prevalence and risk factors of persistent pain after lung cancer surgery and total knee arthroplasty (TKA) in the Japanese population. After receiving Ethics Committee approval, a retrospective chart review was performed for patients who underwent surgery at seven university hospitals in Japan in 2013. A total of 511 patients who underwent lung cancer surgery and 298 patients who underwent TKA were included. The prevalence of chronic postsurgical pain (CPSP) at 3 and 6 months was 18 and 12% after lung surgery and 49 and 33% after TKA, respectively. The prevalence of analgesic use at 3 and 6 months was 16 and 9% after lung surgery and 34 and 22% after TKA, respectively. In both groups, preoperative analgesic use was associated with CPSP. Anesthetic methods or techniques during both types of surgery did not significantly affect the prevalence of CPSP. This is the first study in which the prevalence of CPSP after lung surgery and TKA in Japanese population was extensively evaluated in a multicenter trial. Further prospective studies are needed to confirm the prevalence of CPSP in the Japanese population and to identify risk factors and prevention methods.

Topics: Aged; Aged, 80 and over; Analgesics; Analgesics, Opioid; Anesthesia; Arthroplasty, Replacement, Knee; Chronic Pain; Female; Humans; Japan; Male; Middle Aged; Odds Ratio; Pain, Postoperative; Pregabalin; Prevalence; Retrospective Studies; Risk Factors; Thoracotomy

Inadequate postoperative pain management could lead to persistent pain and this is, in part, due to incomplete understanding of the mechanism of postoperative pain. Currently available rodent models may have limited translatability to clinical postoperative pain. Thus, a preclinical model of postoperative pain was developed in the cynomolgus macaque, a species that is phylogenetically closer to humans than rodents.. The presence of pressure hypersensitivity was assessed with non-noxious pressure applied proximally and distally (approximately 10 cm) to an abdominal incision in macaques. The effect of the opioid morphine (intramuscular, i.m.), the nonsteroidal anti-inflammatory drug diclofenac (i.m.) and the anticonvulsant pregabalin (i.m.) on pressure hypersensitivity was evaluated one and two days following surgery. Brain activation during non-noxious pressure stimulation was observed with functional magnetic resonance imaging.. Hypersensitivity to non-noxious pressure applied proximally and distally (approximately 10 cm) to the incision was observed, lasting for up to seven days and three days, respectively, following surgery. Postoperative pressure hypersensitivity was attenuated with morphine but not with either diclofenac or pregabalin. Bilateral activation of the insular cortex and cingulate cortex was observed during non-noxious pressure stimulation proximal to the incision, which was attenuated with morphine. By contrast, pregabalin reduced only cingulate cortex activation.. The lack of antinociceptive efficacy of pregabalin on postoperative pain could be due to the incomplete suppression of pressure-evoked brain activation. It is speculated that incomplete postoperative pain relief observed in general could be due to residual or persistent activity of key pain nuclei such as the insular cortex. The current macaque model could be used for further elaborating the mechanism of postoperative pain as well as confirming the efficacy of potential treatments for the management of postoperative pain.

Topics: Analgesics; Animals; Brain; Disease Models, Animal; Hyperalgesia; Image Processing, Computer-Assisted; Macaca fascicularis; Magnetic Resonance Imaging; Male; Oxygen; Pain, Postoperative; Physical Stimulation; Pregabalin; Time Factors

Living donor hepatectomy (LDH) has important consequences in terms of acute and chronic pain. We proposed an anesthetic protocol based on the best currently available evidence. We report the results of this protocol's application.. We performed a retrospective descriptive study of 100 consecutive donors undergoing LDH. The protocol included standardized information provided by the anesthetist, pharmacological anxiolysis and preventive analgesia. Specifically, pregabalin premedication (opioid-free) intravenous anesthesia (with clonidine, ketamine, magnesium sulphate and ketorolac) and epidural analgesia were proposed. Postoperative follow-up was conducted by the Postoperative Pain Service. This analysis included 100 patients (53 women, 47 men, median age 32.7 years old [28.4-37.3]), operated by xypho-umbilical laparotomy. All elements of our anesthetic protocol were applied in over 75% of patients, except for the preoperative consultation with a senior anesthesiologist (55%). The median number of applied item was 7 [interquartile range, IQR 5-7]. Median postoperative pain scores were, at rest and at mobilization respectively 3 [IQR 2-4] and 6 [IQR 4.5-7] on day 1; 2 [IQR 1-3] and 5 [IQR 3-6] on day 2; and 2 [IQR 0-3] and 4 [IQR 3-5] on day 3. In conclusion, LDH leads to severe acute pain. Despite the proposal of a multimodal evidence-based protocol, its applicancy was not uniform and the pain scores remained relatively high.

Topics: Adult; Analgesia, Epidural; Anesthesia, Intravenous; Anesthetics; Clonidine; Evidence-Based Medicine; Female; Follow-Up Studies; Hepatectomy; Humans; Ketamine; Ketorolac; Laparotomy; Living Donors; Magnesium Sulfate; Male; Pain Management; Pain, Postoperative; Postoperative Period; Pregabalin; Premedication; Retrospective Studies

The concept of multimodal analgesia is currently widespread in our clinical practice. The aim of multimodal analgesia is to reduce the side effects derived from the drugs or techniques used for the control of pain together with greater effectiveness (combination of multiple mechanisms of action) with the maximum efficiency, that is, to combine different pharmacodynamics (synergistic or additive effects) and pharmacokinetics, in the context of a predictable acute pain model, thus allowing a prior strategy such as the model of acute postoperative pain. Pain is a complex physiological phenomenon. Postoperative pain involves multiple pathways including nociceptive, inflammatory, and neuropathic sources. In the transmission of pain therefore, different molecules participate, which means that there are multiple pharmacological targets on which to act, and therefore a wide range of drugs to be used following the physiology of pain.

Topics: Analgesia; Analgesics; Analgesics, Opioid; Clinical Trials as Topic; Combined Modality Therapy; Dexmedetomidine; Drug Therapy, Combination; Humans; Ibuprofen; Ketamine; Lidocaine; Magnesium; Ondansetron; Pain Management; Pain, Postoperative; Pregabalin

Topics: Analgesics; Animals; Betamethasone; Carcinoma, Squamous Cell; Cat Diseases; Cats; Drug Eruptions; Fusidic Acid; Neuralgia; Pain, Postoperative; Pregabalin; Skin Neoplasms

Topics: Aged; Amputation, Surgical; Analgesics; Anesthetics, Local; Calcitonin; Early Medical Intervention; Female; Forearm; Humans; Ketamine; Liposarcoma; Muscle Neoplasms; Nerve Block; Pain, Postoperative; Phantom Limb; Pregabalin; Ropivacaine; Transcutaneous Electric Nerve Stimulation

Pain management after total knee arthroplasty (TKA) varies and has been investigated for years. Pregabalin as an anticonvulsant agent that selectively affects the nociceptive process has been used for pain relief after operation. This meta-analysis was conducted to examine the evidence of pregabalin in TKA.. Systematic searches of all related literatures were conducted using the following databases: MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials. Only randomized-controlled trials (RCTs) for TKA were included. The postoperative narcotic requirements, visual analog scale scores, knee flexion range, and relative risk of incidence rate of adverse effects in the pregabalin group versus placebo group were extracted throughout the study.. Seven placebo-controlled RCTs met the inclusion criteria. The use of pregabalin significantly decrease the postoperative total morphine consumption (P < .05) and increase the passive knee flexion range (P < .05). Compared with the control group, the incidence of some side effects (nausea, vomiting, pruritus, and constipation) was less in the pregabalin group (P < .05).. The administration of pregabalin is not only efficacious in the reduction of narcotic requirements and incidence of some adverse effect, but also workable for the improvement of passive knee flexion range after TKA.

Topics: Analgesics; Arthroplasty, Replacement, Knee; Humans; Pain, Postoperative; Pregabalin; Randomized Controlled Trials as Topic

Despite the development of multimodal analgesia for postoperative pain management, opioids are still required for effective pain relief after knee arthroplasty. We aimed to identify the determinants of post-operative pain intensity and post-operative opioid requirement in this context.. In this observational prospective study, we recorded patient characteristics, pre-operative pain intensity, anxiety and depression levels, sensitivity and pain thresholds in response to an electrical stimulus, and mu-opioid receptor (OPRM1) and catechol-O-methyltransferase (COMT) single-nucleotide polymorphisms. Multivariate linear regression models were used to identify predictors of post-operative pain at rest and opioid requirement.. We included 109 patients. Pre-operative pain at rest (p = 0.047), anxiety level (p = 0.001) and neuropathic pain symptoms (p = 0.030) were independently and positively associated with mean post-operative pain intensity adjusted for mean post-operative morphine equivalent dose (MED). Mean post-operative pain intensity at rest was lower (p = 0.006) in patients receiving celecoxib and pregabalin in the post-operative period, with all other variables constant. Mean post-operative MED over 5 days was low, but highly variable (78.2 ± 32.1 mg, from 9.9 to 170 mg). Following adjustment for mean post-operative pain intensity, it was independently negatively correlated with age (p = 0.004), and positively correlated with associated paracetamol treatment (p = 0.031). No genetic effect was detected in our sample.. Our findings suggest that clinicians could use the pre-operative pain profile, in terms of anxiety levels, neuropathic pain symptoms, and chronic pre-operative pain intensity, to improve the efficacy of pain management after knee surgery.

Topics: Acute Pain; Aged; Amides; Analgesics; Analgesics, Opioid; Anesthetics, Local; Anxiety; Arthroplasty, Replacement, Knee; Catechol O-Methyltransferase; Celecoxib; Cyclooxygenase 2 Inhibitors; Depression; Female; Humans; Linear Models; Male; Middle Aged; Morphine; Multivariate Analysis; Nerve Block; Pain Management; Pain Threshold; Pain, Postoperative; Polymorphism, Single Nucleotide; Pregabalin; Preoperative Period; Prospective Studies; Receptors, Opioid, mu; Ropivacaine; Severity of Illness Index

Topics: Acute Pain; Analgesics; Humans; Pain, Postoperative; Pregabalin; Preoperative Care

Topics: Acute Pain; Analgesics; Humans; Pain, Postoperative; Pregabalin; Preoperative Care

The genitofemoral neuropathy is one of the most common causes of groin pain after surgery. Especially, the groin pain induced by genitofemoral nerve injury during herniorrhaphy is a well-known complication. In contrast, much attention is not paid for groin pain induced by genitofemoral nerve injury after pelvic surgery, and there have been few reports in males, although it has been reported in females. We report a 59-year-old male patient who suffered from scrotal pain caused by presumed genitofemoral nerve injury during radical cystectomy and bilateral pelvic lymphadenectomy for bladder cancer. The surgical procedure was performed in a supine position under general anesthesia, without epidural anesthesia. Postoperatively, he complained of burning and lancinating pain in bilateral scrotal area. Abnormal findings were not evident using computed tomography and ultrasonography of the pelvis, including the scrotum and testicles. He had severe allodynia of the ventral scrotum and bilateral ventromedial thigh region, with absence of cremasteric reflex. We speculated that his pain might have been surgery-induced genitofemoral neuropathy, which was caused by nerve injury during lymphadenectomy near the external iliac vessels. His scrotal pain and allodynia following the cystectomy were partially and gradually relieved after administering pregabalin, further supporting the contention that his scrotal pain was a surgery-induced neuropathy.

Topics: Analgesics; Cystectomy; Femoral Nerve; Humans; Male; Middle Aged; Pain, Postoperative; Peripheral Nervous System Diseases; Pregabalin; Scrotum

Thirty-one to 97% of patients who undergo thoracotomy for lung cancer experience ipsilateral shoulder pain, marring the otherwise excellent relief provided by thoracic epidural analgesia. The aim of this study was to test whether the addition of pregabalin to the treatment for shoulder pain would provide a significant benefit.. Twenty patients undergoing thoracic surgery for lung cancer were enrolled in the control group between May 2012 and December 2012, and 20 patients were enrolled in the pregabalin group between January 2013 and July 2013, consecutively. All patients had standard pre- and intraoperative care. Patients received pregabalin 150 mg po POD 1 and then non-steroidal anti-inflammatory drugs (NSAIDs) po 2 h later (pregabalin group), or they received only NSAIDs po at exactly the same times (control group). Pain severity was then measured using a 100-mm visual analog scale (VAS) scoring system.. The VAS scores indicated that patients in the pregabalin group had significantly less shoulder pain on postoperative day (POD) 2 than those in the control group (control: 27.9 ± 28.1 vs. pregabalin: 11.8 ± 14.4; p = 0.030). No differences in pain were observed between the two groups on other POD. There were significant differences on only POD 2 in the patients with shoulder pain immediately after surgery. Three of the pregabalin-treated patients showed mild somnolence.. Postoperative administration of pregabalin provided significant relief of postoperative shoulder pain during earlier POD after thoracic surgery for lung cancer when received multimodal analgesia in combination with NSAIDs.

Topics: Adult; Aged; Analgesics; Female; gamma-Aminobutyric Acid; Humans; Lung Neoplasms; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Pilot Projects; Postoperative Complications; Pregabalin; Shoulder Pain; Thoracotomy

There is no established treatment for intercostal neuralgia associated with thoracotomy. We investigated the administration of pregabalin as a new perioperative treatment, assessing its safety and efficacy for intercostal neuralgia after thoracotomy.. Thirty patients suffering pain after thoracotomy severe enough to cause insomnia were prospectively enrolled and treated with 150 mg of pregabalin. We evaluated pain scores (Numeric Rating Scale, NRS), severity of nocturnal insomnia, and adverse effects before and after pregabalin administration.. We noted significant decreases in pain scores, before vs. after pregabalin administration, from 8.2 ± 1.3 to 3.4 ± 1.3 (p < 0.0001), with improvement in nocturnal insomnia in 29 out of 30 patients. Eight patients reported adverse effects, including dizziness and daytime drowsiness; however, by reducing the dose of pregabalin, these effects were minimized while pain was controlled well.. Pregabalin was highly effective for neuralgia associated with intercostal damage after thoracotomy.

Topics: Adult; Aged; Aged, 80 and over; Analgesics; Female; gamma-Aminobutyric Acid; Humans; Intercostal Nerves; Male; Middle Aged; Neuralgia; Pain, Postoperative; Pregabalin; Prospective Studies; Thoracotomy; Treatment Outcome; Young Adult

Topics: Amines; Analgesics; Anesthesiology; Cyclohexanecarboxylic Acids; Gabapentin; gamma-Aminobutyric Acid; Humans; Pain, Postoperative; Perioperative Care; Pregabalin

Chronic postsurgical pain (CPSP) is a common problem, with up to a third of patients reporting persistent or intermittent pain 1 year after common operations. A proposed definition is pain that develops after a surgical procedure, which lasts at least 2 months, and where other causes and preexisting pain have been excluded. A variety of preoperative, intraoperative, and postoperative factors are thought to contribute to the pathogenesis of CPSP. Preventive strategies include effective postsurgical acute pain management, preoperative administration of gabapentin or pregabalin continued postoperatively, and considering the necessity of the surgical procedure itself and exploring alternatives.

Topics: Amines; Chronic Pain; Cyclohexanecarboxylic Acids; Gabapentin; gamma-Aminobutyric Acid; Humans; Pain Management; Pain, Postoperative; Pregabalin; Risk Factors

Multimodal postoperative analgesia employs multiple medications given perioperatively to block the generation and perception of pain at different points in the nociceptive pathway. This retrospective study examines its effect on the length of stay for patients undergoing hindfoot and ankle fusions.. All patients operated upon by the senior authors between 2007 and 2011, inclusive, underwent ankle fusion, subtalar fusion, pantalar arthrodesis, triple arthrodesis, or combined ankle/subtalar fusions. The perioperative pain management was either the "traditional" method (patient-controlled-analgesia-delivered parenteral narcotics beginning immediately postoperatively) or the multimodal pain protocol (pre- and postoperative oral administration of opioids, celecoxib, pregabalin, acetaminophen, and prednisone). The choice of pain protocol was up to the surgeons, without any exclusion criteria. Physical therapy protocols were not changed during the study. The study included 220 patients; 175 received the multimodal protocol and 45 received traditional management. Multimodal protocol patients were younger (53.9 vs 59.7 years; P < .003), but there were no other differences between the groups with respect to gender, obesity, body mass index, tobacco use, alcohol use, or comorbidities. Complex cases (revision surgeries, Charcot joint surgeries, multiple concurrent procedures, etc) were equally represented in both groups.. Multimodal protocol patients had lower lengths of stay (2.5 days; 95% confidence interval [CI], 1.4-3.7) than traditional pain management patients (4.2 days; 95% CI, 2.7-5.7; P < .001). This was also true for both complicated and uncomplicated surgeries when considered separately.. This study provides the first evidence that multimodal therapy reduces the length of stay for patients undergoing major hindfoot or ankle fusion surgery, regardless of surgical complexity.. Level III, comparative series.

Topics: Acetaminophen; Analgesia, Patient-Controlled; Analgesics; Analgesics, Opioid; Anesthesia, General; Anesthesia, Spinal; Ankle Joint; Anti-Inflammatory Agents; Arthrodesis; Celecoxib; Cyclooxygenase 2 Inhibitors; Drug Therapy, Combination; Female; gamma-Aminobutyric Acid; Humans; Hydromorphone; Length of Stay; Male; Middle Aged; Morphine; Oxycodone; Pain Management; Pain, Postoperative; Postoperative Care; Prednisone; Pregabalin; Preoperative Care; Pyrazoles; Retrospective Studies; Subtalar Joint; Sulfonamides

Neuropathic pain is a condition that is still not well understood, although it affects a significantly high percentage of the population. The main problem lies in the fact that it can become a fairly disabling pathology. The most frequent treatment is based essentially on two drugs: gabapentin and pregabalin. Other pharmaceuticals, such as antidepressants, opioids or N-methyl-D-aspartate receptor antagonists can also be employed in combination with the primary drugs. All the same, treatment remains unsatisfactory. Furthermore, it must be borne in mind that there may be patients who are allergic to the two main drugs.. We report the case of a 36-year-old female with neuropathic pain secondary to surgery to correct a neurinoma in the brachial plexus, who could not be treated with gabapentin or pregabalin because of a personal history of allergy to these substances. Treatment with another drug (lacosamide), however, was very effective and displayed a very good response.. Lacosamide is a third-generation antiepileptic drug that has been proven to be effective, safe and with few side effects. It has been considered a good therapeutic option for the treatment of neuropathic pain in patients who are allergic to pregabalin.. Lacosamida como alternativa en el tratamiento del dolor neuropatico posquirurgico en una paciente alergica.. Introduccion. El dolor neuropatico es una entidad que no se conoce bien. Afecta a un porcentaje significativo de la poblacion. Su principal problema radica en que puede llegar a ser una patologia bastante invalidante. El tratamiento principal se basa fundamentalmente en dos farmacos: gabapentina y pregabalina. Otros farmacos, como los antidepresivos, los opioides o los antagonistas de receptores de N-metil D-aspartato tambien pueden utilizarse en combinacion con los farmacos principales. A pesar de esto, el tratamiento es poco satisfactorio. Ademas, debe considerarse que pueden existir pacientes que presenten alergia a los dos farmacos principales. Caso clinico. Mujer de 36 años, afecta de dolor neuropatico secundario a una cirugia de neurinoma del plexo braquial, cuyo tratamiento con gabapentina o pregabalina no era posible por tener antecedentes personales de alergia. Sin embargo, el tratamiento con otro farmaco (lacosamida) resulto muy efectivo, al presentar muy buena respuesta. Conclusion. La lacosamida es un farmaco antiepileptico de tercera generacion, eficaz, seguro y con pocos efectos secundarios. Se ha considerado una buena opcion terapeutica para el tratamiento del dolor neuropatico en pacientes alergicos a la pregabalina.

Topics: Acetamides; Adult; Amines; Analgesics; Anticonvulsants; Brachial Plexus Neuropathies; Contraindications; Cyclohexanecarboxylic Acids; Drug Hypersensitivity; Female; Gabapentin; gamma-Aminobutyric Acid; Humans; Lacosamide; Magnetic Resonance Imaging; Neuralgia; Neurofibroma; Pain, Postoperative; Peripheral Nervous System Neoplasms; Pregabalin

Unfortunately, many patients may have persistent pain lasting for many months, or even years, following thoracic surgery. No effective treatment has so far been established for chronic pain after thoracotomy. There are no reports of treatment involving Pregabalin for pain after thoracic surgery. This study reports four cases that showed significant improvement with Pregabalin in late-onset (notified during an office visit after discharge) nocturnal insomnia and in stress-induced ulcers caused by intercostal neuralgia after thoracotomy.

Topics: Adenocarcinoma; Aged; Analgesics; Carcinoma, Squamous Cell; Chronic Pain; Drug Administration Schedule; Female; gamma-Aminobutyric Acid; Humans; Intercostal Nerves; Lung Neoplasms; Male; Pain, Postoperative; Pneumonectomy; Pregabalin; Thoracotomy; Treatment Outcome

Topics: Amines; Analgesics; Chronic Pain; Cyclohexanecarboxylic Acids; Female; Gabapentin; gamma-Aminobutyric Acid; Humans; Male; Pain, Postoperative; Pregabalin

Patient-controlled analgesia (PCA) is an established standard therapy for providing postoperative analgesia. To avoid possible abuse by patients each PCA pump is secured by a pin code that should be neither known nor accessible to patients. The two case reports described illustrate how manipulation of a PCA pump led to massive opioid abuse by the patients who decoded the pin code for unlimited additional doses. One patient developed withdrawal symptoms after switching the therapy and, as a consequence even had to be admitted to the intensive care unit (ICU). Easy access to the PCA pump codes on the internet for the patients and the impossibility of changing the pin codes by the medical staff played an important role in these two cases.

Topics: Adolescent; Adult; Analgesia, Patient-Controlled; Analgesics, Opioid; Codeine; Critical Care; Drug Overdose; Electronic Data Processing; Female; gamma-Aminobutyric Acid; Humans; Internet; Male; Opioid-Related Disorders; Pain, Postoperative; Physicians; Pregabalin; Wounds, Gunshot

Perioperative pain management has recently been revolutionized with the recognition of novel mechanisms and introduction of newer drugs. Many randomized trials have studied the use of the gabapentinoid anti-epileptic, pregabalin, in acute pain. Published systematic reviews suggest that using pregabalin for perioperative pain management may decrease analgesic requirements and pain scores, at the expense of troublesome side effects. A major limitation of the extant reviews is the lack of rigorous investigation of clinical characteristics that would maximize the benefit harms ratio in favor of surgical patients. We posit that effects of pregabalin for perioperative pain management vary by the type of surgical pain model and propose this systematic review protocol to update previous systematic reviews and investigate the heterogeneity in findings across subgroups of surgical pain models.. Using a peer-reviewed search strategy, we will search key databases for clinical trials on perioperative pregabalin use in adults. The electronic searches will be supplemented by scanning the reference lists of included studies. No limits of language, country or year will be imposed. Outcomes will include pain; use of co-analgesia, particularly opioids; enhanced recovery; and drug-related harms. We will focus on the identification of surgical models and patient characteristics that have shown benefit and adverse effects from pregabalin.Two clinical experts will independently screen the studies for inclusion using eligibility criteria established a priori. Data extracted by the reviewers will then be verified. Publication bias will be assessed, as will risk of bias using the Cochrane Risk of Bias tool. Meta-analysis and meta-regression are planned if the studies are deemed statistically, methodologically and clinically homogenous. Evidence will be graded for its strength for a select number of outcomes.. We will explore the findings of perioperative clinical trials studying the use of pregabalin for acute pain. We will comment on the implications of the findings and provide further direction for the appropriate use of pregabalin in acute pain. This protocol will attempt to bridge the growing gap between clinical experience and emerging evidence, and has the potential to aid future guideline development in the perioperative use of pregabalin.. PROSPERO registration number CRD42012002078.

Topics: Adult; Analgesics; gamma-Aminobutyric Acid; Humans; Pain, Postoperative; Pregabalin; Research Design; Systematic Reviews as Topic

Pain reduction is important for early mobilization after total knee arthroplasy. Recent studies show that local infiltration analgesia and addition of anti-hyperalgesic drugs (pregabalin and s-ketamine) may improve postoperative analgesia and mobilization. This pilot study was meant to evaluate if this new method of analgesia might improve patients' ability to exercise in the first postoperative days. The secondary goal was to determine what side effects could be expected by using this drug combination. A pilot study showed that patients achieved knee flexion of 88.5 degrees (SD 9.6) already on the second postoperative day. The side effects were mild and mostly self-limiting.

Topics: Acetaminophen; Aged; Analgesia; Analgesics; Analgesics, Non-Narcotic; Anesthetics, Dissociative; Arthroplasty, Replacement, Knee; Exercise Therapy; Female; gamma-Aminobutyric Acid; Humans; Ketamine; Knee; Length of Stay; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Physical Therapy Modalities; Preanesthetic Medication; Pregabalin; Recovery of Function; Treatment Outcome

Glossopharyngeal neuralgia is a rare condition and the origin is mostly idiopathic. Causes of symptomatic glossopharyngeal neuralgia can be tumors, infarction or trauma. We report the case of a 28-year-old patient who developed glossopharyngeal neuralgia after resection of a glossopharyngeal schwannoma, which is an extremely rare tumor. Treatment consisted of orally administered pregabalin and a series of injections of buprenorphine in the superior cervical ganglion (ganglionic local opioid application/analgesia, GLOA) which led to a substantial decrease in the frequency of pain attacks. This improvement was maintained at 1-year follow-up. This is the first report of development of glossopharyngeal neuralgia after resection of a glossopharyngeal schwannoma.

Topics: Administration, Oral; Adult; Analgesics; Analgesics, Opioid; Autonomic Nerve Block; Buprenorphine; Chronic Disease; Female; gamma-Aminobutyric Acid; Glossopharyngeal Nerve; Glossopharyngeal Nerve Diseases; Humans; Injections; Magnetic Resonance Imaging; Neurilemmoma; Pain Measurement; Pain, Postoperative; Pregabalin; Superior Cervical Ganglion

Topics: Acute Disease; Analgesics, Non-Narcotic; gamma-Aminobutyric Acid; Humans; Meta-Analysis as Topic; Pain, Postoperative; Pregabalin; Research Design

Pain management after total hip arthroplasty has improved dramatically in the past decade. However, most protocols use opioid medications for pain control. In the current study, 100 patients were prospectively selected to receive a traditional narcotic-based patient-controlled analgesia protocol or a nonnarcotic oral protocol for pain management after primary total hip arthroplasty. Therapy programs were similar for both groups. Postoperatively, patients were followed daily for opioid use, medication adverse effects, pain control, and overall satisfaction. The nonnarcotic oral group showed lower mean pain scores during the first 24 hours after surgery. The satisfaction rate was high in both groups. Both protocols provided adequate pain control after total hip arthroplasty; the nonnarcotic pain management protocol resulted in significantly decreased opioid consumption and fewer adverse effects.

Topics: Acetaminophen; Adult; Aged; Aged, 80 and over; Analgesics, Non-Narcotic; Arthroplasty, Replacement, Hip; Celecoxib; Dextropropoxyphene; Female; Fentanyl; gamma-Aminobutyric Acid; Hip Prosthesis; Humans; Male; Middle Aged; Narcotics; Oxycodone; Pain, Postoperative; Patient Satisfaction; Pregabalin; Prospective Studies; Pyrazoles; Sulfonamides; Surveys and Questionnaires; Treatment Outcome

Minimally invasive surgical techniques have many benefits, including reduced postoperative pain. Despite this, most patients require opioid analgesia, which can have significant side effects and toxicity. We report the first urologic study using multimodal analgesia with pregabalin, a gabapentinoid.. The present retrospective study included 60 patients who underwent robotic-assisted laparoscopic radical prostatectomy. Of the 60 patients, 30 received multimodal treatment with pregabalin 150 mg, acetaminophen 975 mg, and celecoxib 400 mg orally 2 hours before the start of the procedure and continued postoperatively. These patients were compared with 30 consecutive previous patients, who had received a standard postoperative analgesic regimen with intravenous ketorolac 15 mg every 6 hours with oxycodone 5 mg and acetaminophen 325 mg, 1 to 2 tablets, every 4 hours as needed for pain.. The patients in the multimodal treatment group had a significantly reduced intraoperative opioid requirement, as measured by the mean morphine equivalent dose administered (38.4 ± 2.73 mg vs 49.1 ± 2.65 mg; P < .01). The mean postoperative opioid use was also significantly reduced (10.7 ± 2.82 mg vs 26.2 ± 6.56 mg; P = .034), as was the mean total morphine equivalent dose administered (49.1 ± 2.7 mg vs 75.3 ± 4.6 mg; P < .001). The operative time, estimated operative blood loss, antiemetic use, postoperative creatinine and hemoglobin levels, and length of stay were similar in the 2 groups. No operative or treatment complications occurred in either group.. The present retrospective review has indicated that a multimodal analgesic approach with pregabalin and celecoxib administered preoperatively decreases intraoperative and postoperative opioid use in patients undergoing robotic-assisted laparoscopic radical prostatectomy.

Topics: Acetaminophen; Analgesics; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Celecoxib; Cyclooxygenase 2 Inhibitors; Drug Therapy, Combination; gamma-Aminobutyric Acid; Humans; Intraoperative Period; Ketorolac; Laparoscopy; Male; Middle Aged; Morphine; Oxycodone; Pain, Postoperative; Pregabalin; Premedication; Prostatectomy; Pyrazoles; Robotics; Sulfonamides

Topics: Acute Disease; Analgesics, Non-Narcotic; Drug Administration Schedule; gamma-Aminobutyric Acid; Humans; Pain, Postoperative; Pregabalin

Topics: Analgesics; Anti-Anxiety Agents; Anxiety; gamma-Aminobutyric Acid; Humans; Hypnotics and Sedatives; Melatonin; Pain, Postoperative; Periodicals as Topic; Pregabalin; Publication Bias; Randomized Controlled Trials as Topic; Research Design; Sleep; Surgical Procedures, Operative; Treatment Failure; Treatment Outcome

Topics: Aged; Amputation, Surgical; Analgesics; Confusion; gamma-Aminobutyric Acid; Humans; Hyponatremia; Male; Pain, Postoperative; Pregabalin

Topics: Amines; Analgesics; Clinical Trials as Topic; Cyclohexanecarboxylic Acids; Dose-Response Relationship, Drug; Gabapentin; gamma-Aminobutyric Acid; Humans; Pain, Postoperative; Pregabalin; Shoulder Pain; Thoracotomy

Topics: Analgesics; gamma-Aminobutyric Acid; Humans; Male; Pain, Postoperative; Pelvic Pain; Peripheral Nervous System Diseases; Pregabalin; Prostatectomy; Prostatic Diseases

Topics: Amines; Analgesics; Cyclohexanecarboxylic Acids; Gabapentin; gamma-Aminobutyric Acid; Humans; Pain, Postoperative; Pregabalin

Gabapentin and S-(+)-3-isobutylgaba are anticonvulsant agents that selectively interact with the alpha2delta subunit of voltage-dependent calcium channels. This report describes the activities of these two compounds in a rat model of postoperative pain. An incision of the plantaris muscle of a hind paw induced thermal hyperalgesia and tactile allodynia lasting at least 3 days. Postoperative testing was carried out using the plantar test for thermal hyperalgesia and von Frey hairs for tactile allodynia. A single s.c. dose of gabapentin, 1 h before surgery, dose-dependently (3-30 mg/kg) blocked the development of allodynia and hyperalgesia with a minimum effective dose (MED) of 10 and 30 mg/kg, respectively. The highest dose of gabapentin prevented development of hyperalgesia and allodynia for 24 and 49 h, respectively. Similar administration of S-(+)-3-isobutylgaba also dose-dependently (3-30 mg/kg, s.c.) prevented development of hyperalgesia and allodynia with MED of 3 and 10 mg/kg, respectively. The highest dose of S-(+)-3-isobutylgaba completely blocked development of both nociceptive responses for 3 days. The administration of S-(+)-3-isobutylgaba (30 mg/kg s.c.) 1 h after surgery also completely blocked the maintenance of hyperalgesia and allodynia, but its duration of action was much shorter (3 h). The administration of morphine (1-6 mg/kg s.c.) 0.5 h before surgery prevented the development of thermal hyperalgesia with a MED of 1 mg/kg. However, unlike gabapentin and S-(+)-3-isobutylgaba, it had little effect on the development of tactile allodynia. It is suggested that gabapentin and S-(+)-3-isobutylgaba may be effective in the treatment of postoperative pain.

Topics: Acetates; Amines; Analgesics; Animals; Anticonvulsants; Cyclohexanecarboxylic Acids; Gabapentin; gamma-Aminobutyric Acid; Male; Morphine; Pain, Postoperative; Pregabalin; Rats; Rats, Sprague-Dawley