Effect of Pregabalin on Postcraniotomy Pain in Patients Undergoing Supratentorial Tumor Surgery: A Randomized, Double-Blind, Placebo-Controlled Trial

Abstract

Background and Objectives Suboptimal management of postcraniotomy pain causes sympathetic and hemodynamic perturbations, leading to deleterious effects on the neurological system and overall patient outcome. Opioids are the mainstay of postoperative pain management but have various problems when given in high doses, or for prolonged durations in neurosurgical patients. The ideal method of pain control following craniotomy generally relies on a combination of various drugs. Oral pregabalin may be an attractive alternative in these patients. Materials and Methods Sixty, American Society of Anesthesiologists class I and II patients posted for elective supratentorial craniotomy, aged 18 and 60 years, were randomly assigned into three groups of 20 each to receive oral placebo (Group A), pregabalin 75 mg (Group B), or pregabalin 150 mg (Group C) before the induction of anesthesia. At the end of the surgery, patient-controlled analgesia was started with intravenous fentanyl. Visual analog scale (VAS) score was recorded every 2 hours for 24 hours, along with total postoperative fentanyl requirement. Results There were no differences in sex, duration of surgery or anesthesia and total intraoperative fentanyl administered among the three groups. The median postoperative VAS score (Group A—18.0, Group B—20, and Group C—22.0; p = 0.63) was similar in all the groups. However, postoperative fentanyl requirement over 24 hours was least in the group that received 150 mg pregabalin (Group A—190 μg, Group B—240 μg, and Group C—100 μg; p = 0.03). Conclusions Even though pain scores were not significantly different, patients receiving 150 mg oral pregabalin required the least amount of postoperative opioids.

A Meta-Analysis Showing the Quantitative Evidence Base of Preemptive Pregabalin for Postoperative Pain from Cancer-Related Surgery

“…A total of 76 articles were eligible for full-text review, and 63 articles were excluded from analysis due to irrelevant intervention ( n = 40), non-cancer-related surgery ( n = 22), and the clinical protocol ( n = 1). Finally, 13 trials (from 30 to 111 patients) were incorporated for quantitative synthesis [ 22 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 47 , 48 ]. The PRISMA flow diagram of this review was illustrated in Figure 1 .…”

“…The cancer type was breast cancer in eight out of the 13 included trials [ 27 , 29 , 31 , 32 , 35 , 36 , 47 , 48 ]. The other five trials that were not breast cancer included bladder cancer, supratentorial tumor, gynecological malignancies, lung cancer, and pleural cancer [ 22 , 28 , 30 , 33 , 34 ]. Twelve trials were carried out under general anesthesia [ 22 , 27 , 28 , 29 , 30 , 31 , 33 , 34 , 35 , 36 , 47 , 48 ] and one trial was performed under general plus local anesthesia which was incisional infiltration consisting of levobupivacaine [ 32 ].…”

“…The other five trials that were not breast cancer included bladder cancer, supratentorial tumor, gynecological malignancies, lung cancer, and pleural cancer [ 22 , 28 , 30 , 33 , 34 ]. Twelve trials were carried out under general anesthesia [ 22 , 27 , 28 , 29 , 30 , 31 , 33 , 34 , 35 , 36 , 47 , 48 ] and one trial was performed under general plus local anesthesia which was incisional infiltration consisting of levobupivacaine [ 32 ]. The postoperative rescue analgesic was morphine in all studies [ 22 , 27 , 28 , 29 , 31 , 33 , 34 , 35 , 36 , 47 , 48 ], except for two studies that used fentanyl [ 30 ] or tramadol [ 32 ], respectively.…”

“…The co-primary outcomes included the following: (1) resting pain scores postoperatively at 24 h (cm); (2) dynamic pain scores postoperatively at 24 h (cm). As a result of its frequent reporting, we chose this time point [ 22 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ].…”

Pregabalin: A Drug Useful in the Management of Pain after Craniotomy?

“…In this issue of the Journal of Neurosciences in Rural Practice , the authors present a topic that is part of this new and interesting line of research. 3 It proposes a randomized, double-blind, placebo-controlled trial of notable relevance and importance in both cultural clarification and practical clinical use: the effect of pregabalin on postcraniotomy pain in patients undergoing supratentorial tumor surgery.…”