Perioperative pregabalin for reducing pain, analgesic consumption, and anxiety and enhancing sleep quality in elective neurosurgical patients: a prospective, randomized, double-blind, and controlled clinical study

Abstract

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 ).

Preoperative sleep quality predicts postoperative pain after planned caesarean delivery

“…In a cohort of patients undergoing total knee replacement, a strong correlation between sleep quality as assessed with polysomnography and postoperative active range of motion was reported (Gong et al., ). In another cohort of neurosurgical patients, preoperative pregabalin significantly improved preoperative sleep quality and also reduced postoperative pain intensity, although in this study, pregabalin may have had a direct analgesic effect (Shimony et al., ).…”

Is early postoperative administration of pregabalin beneficial for patients with lung cancer?—randomized control trial

“…Moreover, the action of antidepressants has been reported to reduce anxiety and sleep quality in surgical patients, as well as to reduce pain and analgesic consumption (22). Identification and reduction of psychological factors can also help to optimize pain management in thoracic surgery.…”

Postoperative Pain Control Following Craniotomy: A Systematic Review of Recent Clinical Literature

“…Interestingly, administration of pregabalin 150 mg on the evening before surgery, as premedication 2 hours before surgery, and twice per day for 72 hours after craniotomy improved pain scores and reduced analgesic consumption during hospitalization, an effect extended to 3 months after surgery. Furthermore, administration of pregabalin was related to fewer side effects, such as PONV, anxiety, and sleep disorders up to hospital discharge …”

“…Presumably, the failure to identify any clear positive effect of premedication with 600 mg of gabapentin on postcraniotomy pain relief and opioid consumption during the 18‐hour follow‐up period was due to inadequate dosing, as it has been shown that a dose of 1,200 mg/day might be needed for successful analgesic effect following craniotomy . However, preemptive administration of 150 mg pregabalin and twice‐daily dosing for 3 days following craniotomy optimally affected antinociception and the occurrence of adverse effects during the first 48 hours after craniotomy . Considering that the clinical effects of gabapentinoids are not solely pharmacologically modulated but may also depend upon the activities of unidentified neurological pathways, such as pain neuroadaptation, more studies are warranted to elucidate their potential role in the neurosurgical setting, both on a short‐term and long‐term basis …”

“…Methodological quality assessment demonstrated an acceptable risk of bias ( Table 2). Postoperative pain constituted the primary outcome in 15 studies, [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] while in the remaining studies the main point of interest was intraoperative performance, 28,29 postoperative nausea and vomiting (PONV), 30 or cost analysis of the tested analgesics. 31 On the basis of analgesic regimen used for postcraniotomy pain management, the selected articles were divided into 3 subcategories: systemic pharmacological intervention, [13][14][15][16][17][18][19][20][21][22][23]28,30,31 scalp infiltration/block, [24][25][26] and nonpharmacological intervention mainly involving acupuncture, 27,29 enrolling a total of 1,805 patients of both sexes.…”