Perioperative Administration of Pregabalin and Esketamine to Prevent Chronic Pain After Breast Cancer Surgery: A Randomized Controlled Trial

Abstract

Background 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. Methods 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. Results The incidence of chronic pain in the EP group was significantly lower than in the Control group three (14.3% vs 46.3%, P = 0.005) and six (7.1% vs 31.7%, P = 0.009) months postoperatively. The rest numerical rating scale (NRS) pain scores 1–3 days postoperatively and coughing NRS pain scores 1–7 days postoperatively in the EP group were significantly lower than in the Control group (all P ˂ 0.05). The cumulative sufentanil consumption in the EP group during postoperative 0–12, 12–24, and 24–48, 0–24, and 0–48 hours were significantly lower than in the Control group (all P ˂ 0.05). Conclusion Combined perioperative oral pregabalin and postoperative esketamine effectively prevented chronic pain after breast cancer surgery, improved acute postoperative pain, and reduced postoperative opioid consumption.

Esketamine combined with sufentanil versus sufentanil in patient-controlled intravenous analgesia: a meta-analysis

“…et al, 2022 ; Wang N. et al, 2022 ; Cai et al, 2022 ; Chi et al, 2022 ; Wang Y. et al, 2022 ; Wang W. et al, 2022 ; Han et al, 2022 ; He et al, 2022 ; Jiang et al, 2022 ; Li et al, 2022 ; Liang, 2022 ; Luo et al, 2022 ; Peng et al, 2022 ; Qiu et al, 2022 ; Qiu and Wang, 2022 ; Wang, 2022 ; Xu and Li, 2022 ; Zhang et al, 2022 ; Zheng et al, 2022 ; Zhou et al, 2022 ; Yang B. et al, 2023 ; Zhang et al, 2023a ; Yang SQ. et al, 2023 ; Gui et al, 2023 ; Han et al, 2023 ; Su et al, 2023 ; Wang et al, 2023 ; Xie et al, 2023 ) described the details of random sequence generation. Twelve studies ( Li, 2021 ; Yan, 2021 ; Chi et al, 2022 ; Wang W. et al, 2022 ; Han et al, 2022 ; Luo et al, 2022 ; Qiu and Wang, 2022 ; Zheng et al, 2022 ; Zhang et al, 2023a ; Yang SQ.…”

“…Twelve studies ( Li, 2021 ; Yan, 2021 ; Chi et al, 2022 ; Wang W. et al, 2022 ; Han et al, 2022 ; Luo et al, 2022 ; Qiu and Wang, 2022 ; Zheng et al, 2022 ; Zhang et al, 2023a ; Yang SQ. et al, 2023 ; Han et al, 2023 ; Wang et al, 2023 ) described the blinding method of participants and people and were thus considered to have a low risk of bias for this domain, while the remaining 20 studies did not describe the blinding methods and were considered to have an unclear risk of bias. Ten studies ( Li, 2021 ; Chi et al, 2022 ; Wang W. et al, 2022 ; Han et al, 2022 ; Qiu and Wang, 2022 ; Zheng et al, 2022 ; Zhang et al, 2023a ; Yang SQ.…”

“…Ten studies ( Li, 2021 ; Chi et al, 2022 ; Wang W. et al, 2022 ; Han et al, 2022 ; Qiu and Wang, 2022 ; Zheng et al, 2022 ; Zhang et al, 2023a ; Yang SQ. et al, 2023 ; Han et al, 2023 ; Wang et al, 2023 ) described the methods of assigning concealment. Detailed information on the methodological quality of the included studies is shown in Figure 2 .…”