Preemptive Pregabalin in Children and Adolescents Undergoing Posterior Instrumented Spinal Fusion

Abstract

Background: Pregabalin as part of a multimodal pain management regimen has been shown to reduce opioid consumption after spinal surgery in adults, but not in adolescents. Pregabalin has been found to have neuroprotective effects and could therefore have positive impact on pain after spinal deformity surgery. We conducted a randomized, double-blind, placebo-controlled clinical trial with pregabalin on pediatric patients undergoing spinal fusion. Methods: Adolescents with adolescent idiopathic scoliosis, Scheuermann kyphosis and spondylolisthesis, aged 10 to 21 years, scheduled for posterior spinal fusion with all pedicle screw instrumentation were randomized to receive preoperatively and five days after surgery either pregabalin 2mg/kg twice daily or placebo. The primary outcome was total opioid consumption and was measured using patient-controlled analgesia. Postoperative pain scores and opioid adverse effects were evaluated. Results: Sixty-three patients out of 77 eligible were included and analyzed. Cumulative oxycodone consumption per kilogram did not differ between the study groups during the first 48 hours postoperatively, median (95% confidence interval) 1.44 mg/kg (1.32-1.67) in the pregabalin vs. 1.50 mg/kg (1.39-1.79) in the placebo group, p=0.433. Subgroup analysis with only AIS patients showed the same result, mean (95% confidence interval) 1.45 mg/kg (1.24, 1.65) in pregabalin group and 1.59 mg/kg (1.37, 1.82) in placebo group. Total oxycodone consumption per hour (mg/kg/h) was not different between the groups over the time points (p=0.752). The postoperative pain scores did not differ statistically between the study groups (p=0.196). Conclusions: Paediatric pregabalin 2 The use of perioperative pregabalin does not reduce the opioid consumption or affect the pain scores in adolescents after posterior spinal fusion surgery.

Pregabalin and Persistent Postoperative Pain Following Posterior Spinal Fusion in Children and Adolescents

“…Pregabalin or gabapentin has been shown to reduce postoperative opioid consumption in adults undergoing a surgical procedure in the spine 8,9 ; however, in our previous study, preemptive pregabalin did not reduce pain scores or the need for postoperative opioids in children and adolescents 10 . Pregabalin has been found to have neuroprotective effects 11 and is indicated for neuropathic pain in both children and adults.…”

“…The data regarding acute postoperative pain and opioid consumption has been analyzed and published in our previous paper. 10…”

“…8,9 However, in our previous study preemptive pregabalin did not reduce the pain scores or the need for postoperative opioids in children and adolescents. 10 Pregabalin has been found to have neuroprotective effects 11 and is indicated for neuropathic pain in both children and adults. However, there are no previous randomized studies about pregabalin on the persistent postoperative pain in children and adolescents.…”

A retrospective cohort study of bleeding characteristics and hidden blood loss after segmental pedicle screw instrumentation in neuromuscular scoliosis as compared with adolescent idiopathic scoliosis

“…The strengths of our study are a relatively large consecutive number of NMS patients whose results were compared with AIS patients undergoing similar type of operation (segmental pedicle screw instrumentation) using prospectively collected data from a pediatric spine register. Anesthetic management was standardized including tranexamic acid bolus and infusion as previously published [50] .To our knowledge, this is the largest study cohort from a single center with standardized surgical and anesthetic protocol assessing bleeding characteristics in NMS patients. This is the first paper to report hidden blood loss in NMS patients.…”

Postoperative Analgesia After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

“…36 A similar randomized study with 63 participants using pregabalin found no difference with respect to postoperative opioid consumption or pain scores. 37 A randomized study involving a single preoperative dose of gabapentin did not significantly change postoperative opioid consumption or pain scores. 38 A retrospective study found that addition of gabapentin or gabapentin and clonidine regimens to IV morphine PCA reduced opioid use and decreased length of hospital stay.…”