Evaluation of Pregabalin as an Adjuvant to Patient-controlled Epidural Analgesia during Late Termination of Pregnancy

Abstract

Introduction: Late termination of pregnancy combines psychological distress with severe physical pain. The present study evaluated the benefit of adding oral pregabalin to epidural analgesia during this procedure. Methods: Healthy women were randomly allocated to receive either oral pregabalin 150 mg/12 h or prazepam 10 mg/12 h at the induction of the late termination of pregnancy procedure. When they felt abdominal pain (numerical rating scale ranging from 0 [no pain] to 100 [worst pain possible]), patientcontrolled epidural analgesia was activated and set to deliver ropivacaine 0.1% with sufentanil 0.25 g/ml, 5 ml/h with a bolus dose of 5 ml/30 min. Rescue analgesia was available as needed by administration of 10 ml ropivacaine 0.1% (pain score less than 60/100) or 0.2% (at least 60/100). The primary outcome was the consumption of epidural analgesics. Results: Forty-eight patients participated in the study. Demographic and obstetric data were similar. Pregabalin reduced total ropivacaine consumption 11.3 Ϯ 3.2 mg/h (mean Ϯ SD) versus 15.1 Ϯ 4.9 mg/h in the prazepam group (P ϭ 0.005), an effect related to a decrease in the need for rescue analgesia. In the pregabalin group, fewer women asked for rescue dose (75 vs. 96%; P ϭ 0.048), and the number of rescue doses per patient was reduced (1 [0 -2] vs. 2 [1-3]); median [interquartile range], P ϭ 0.005), particularly the need for ropivacaine 0.2%. Discussion: This is the first study considering the use of pregabalin for labor pain associated with late termination of pregnancy, showing that pregabalin 150 mg/12 h is a helpful adjuvant to epidural analgesia. Modulation of both visceral sensitization and affective component of pain may contribute to the benefits observed. L ATE termination of pregnancy (LTOP) procedures (i.e., medical abortions for severe congenital anomalies or intrauterine death at gestational age greater than or equal to 22-24 weeks) represent only 3% of abortions.1 Because of its rare occurrence, the management of pain during the procedure has not received a major interest.Pain experienced in medical abortions causes significant distress whatever the term of the pregnancy.2 In LTOP, the physical pain due to visceral sensitization from induced labor and cervical ripening is severe and associated with major psychological distress. Epidural analgesia, which is currently the most effective way to manage labor pain, is also effective to alleviate pain during LTOP without interfering with the procedure.3 However, in the context of LTOP, where any pain is poorly perceived by the parturient, satisfactory pain relief may remain a challenge for the anesthesiologist. Gabapentin and its analog pregabalin differ structurally and mechanistically from other analgesics. They have been designed as analogs of ␥-aminobutyric acid, but their mechanism of action mostly relies on binding to ␣2-␦ subunit of voltage-gated calcium channels in the central nervous system. 4,5 In clinical practice, they have demonstrated effectiveness to relieve epileptic seizures an...

Study of Attenuation of Cardiovascular Response during Laryngoscopy and Intubation Using Two Different Doses of Pregabalin as Premedication in Controlled Hypertensive Patients- A RCT

“…Analgesia was measured according to VAS score in immediate postoperative period and follow up was done till 6 hour. This study has similar findings with that of Jokela et al (2008) [22], Sarawat et al [23], Peng et al [24], Patricia et al [25], Burke et al [26], Kim et al [27], Mathiesen et al [28]. All these have reported the analgesic property of pregabalin.…”

Comparison of 2 Different Doses of Oral Pregabalin as Premedication on Haemodynamic Pressor Response During Intubation and Extubation in Modified Radical Mastectomy Patients

“…50 mg and it was found that the time for need of rescue analgesia was significantly more in pregabalin groups than control group and significant difference was found between 2 doses of pregabalin in this respect. These findings are in accordance to Jokela et al, [16] Sarawat et al, [17] Peng et al, 18 Patricia et al, [19] Burke et al, [20] Kim et al [21] They all reported the good analgesic property of pregabalin. Various mechanisms may contribute to pregabalin analgesic property such as the modulation of visceral pain and central sensitisation.…”

Efficacy and safety of perioperative pregabalin for post‐operative pain: a meta‐analysis of randomized‐controlled trials

“…One‐hundred and six references were obtained, in which 22 published studies on the perioperative use of pregabalin met our inclusion criteria 5–6,10–29 …”

“…The duration of assessment for post‐operative pain was for 1 day or less in 10 studies, 6,10,11,17,18,20–23,27 for 2 days in three studies, 12,13,19 for 3 days in one study 13 and for 7 days in three studies 14,24,29 …”