pregabalin and Postoperative-Nausea-and-Vomiting

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

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

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

Nonopioid adjuvant medications are increasingly included among perioperative Enhanced Recovery After Surgery protocols. Preoperative pregabalin has been shown to improve postoperative pain and limit reliance on opioid analgesia. Our group investigated the ability of preoperative pregabalin to also prevent postoperative nausea and vomiting (PONV).. Our group performed a meta-analysis of randomized trials that report outcomes on the effect of preoperative pregabalin on PONV endpoints in patients undergoing general anesthesia.. Among all included trials (23 trials; n = 1693), preoperative pregabalin was associated with a significant reduction in PONV (risk ratio [RR] = 0.53; 95% confidence interval [CI], 0.39-0.73; P = 0.0001), nausea (RR = 0.62; 95% CI, 0.46-0.83; P = 0.002), and vomiting (RR = 0.68; 95% CI, 0.52-0.88; P = 0.003) at 24 hours. Subgroup analysis designed to account for major PONV confounders, including the exclusion trials with repeat dosing, thiopental induction, nitrous oxide maintenance, and prophylactic antiemetics and including high-risk surgery, resulted in similar antiemetic efficacy. Preoperative pregabalin is also associated with significantly increased rates of postoperative visual disturbance (RR = 3.11; 95% CI, 1.34-7.21; P = 0.008) compared with a control.. Preoperative pregabalin is associated with significant reduction of PONV and should not only be considered as part of a multimodal approach to postoperative analgesia but also for prevention of PONV.

Topics: Analgesics; Humans; Postoperative Nausea and Vomiting; Pregabalin; Preoperative Care; Randomized Controlled Trials as Topic; Treatment Outcome

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

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

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

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 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

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

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

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

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

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

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

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

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