Perioperative use of pregabalin for acute pain—a systematic review and meta-analysis

Abstract

Evidence supporting postoperative pain management using pregabalin as an adjunct intervention across various surgical pain models is lacking. The objective of this systematic review was to evaluate "model-specific" comparative effectiveness and harms of pregabalin following a previously published systematic review protocol. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched from inception through August 2013. Data were screened and single extraction with independent verification and dual risk of bias assessment was performed. Quality of evidence (QoE) was rated using the GRADE approach. Primary outcomes were pain relief at rest and on movement and reduction in postoperative analgesic consumption. A total of 1423 records were screened, and 43 studies were included. Perioperative pregabalin resulted in: 16% (95% confidence interval [CI], 9%-21%) reduction in analgesic consumption (moderate QoE, 24 trials) and a small reduction in the magnitude of pain in surgeries associated with pronociceptive pain. Per 1000 patients, 10 more will experience blurred vision (95% CI, 5-20 more; moderate QoE, 17 trials) and 41 more sedation (95% CI, 13-77 more, 17 trials). To prevent 1 case of perioperative nausea and vomiting, the number needed to treat is 11 (95% CI: 7-28, 25 trials). Inadequate evidence addressed outcomes of enhanced recovery and serious harms. Pregabalin analgesic effectiveness is largely restricted to surgical procedures associated with pronociceptive mechanisms. The clinical significance of observed pregabalin benefits must be weighed against the uncertainties about serious harms and enhanced recovery to inform the careful selection of surgical patients. Recommendations for future research are proposed.

Pregabalin Reduces Postoperative Opioid Consumption and Pain for 1 Week After Hospital Discharge but Does Not Affect Function at 6 Weeks or 3 Months After Total Hip Arthroplasty

“…spine, joint arthroplasty, and amputations). 46 The present results do not support the hypothesis of superior functional performance long term in the pregabalin vs the placebo group. …”

Is analysis of pregabalin outcomes by surgical pain model evidence based?

“…We read with interest the meta-analysis by Eipe et al 4 However, we believe that the main conclusion of the review "we have demonstrated that pregabalin effectiveness is largely restricted to surgical procedures with pronociceptive mechanisms" is not reflected in the results. Indeed, it appears that many basic statistical and methodological issues are present.…”

“…4 Our hypothesis was based on our previously published clinical decision algorithm. 3 This hypothesis also is supported by the fact that pregabalin is a well-established analgesic for neuropathic pain.…”

Coadyuvantes farmacológicos con efecto ahorrador de opioides en el periodo perioperatorio

“…Curiosamente, los autores no encontraron diferencias significativas en los resultados del dolor agudo al comparar los regímenes de una sola administración preoperatoria de pregabalina (100-300 mg) a la administración posoperatoria repetida (22). Dos metanálisis posteriores también encontraron disminuciones en el consumo de opioides perioperatorios con pregabalina (23,24). En una reciente revisión sistemática se incluyeron ensayos clínicos aleatorizados que investigaron el tratamiento de pregabalina perioperatoria en pacientes quirúrgicos adultos.…”