Preemptive Pregablin: Efficacy on Postoperative Pain Relief and Opioid Sparing in Lower Abdominal Surgeries

Abstract

OBJECTIVES:We aimed to evaluate the preemptive analgesic properties of pregabalin, an anticonvulsant drug used in clinical practice for the treatment of neuropathic pain. METHODS: This study was performed on 40 patients from ASA I-II risk group aged 18-60 years which underwent lower abdominal surgeries. Group I received 300 mg pregabalin and Group II was given a placebo in oral capsule form. Visual analog scale (VAS) scores, morphine consumption and side effects of all patients were recorded at 1, 4, 8, 12 and 24 hours postoperatively. When Aldrette recovery score reached 9, morphine 0.75mcg/kg was given as rescue analgesia. RESULTS: There was no difference observed in the first analgesic requirement time values between the two groups (p>0.05). A statistically significant decrease was observed in the VAS scores of the pregabalin group at 1, 4, 12 and 24 hours after surgery (p<0.005). Total morphine consumption in the pregabalin group was statistically significantly lower than in the control group at 8, 12 and 24 hours after surgery (p<0.005). No significant difference was observed between the two groups regarding side effects during the first postoperative 24 hours (p>0.05). CONCLUSION: Our study demonstrated that a 300 mg pregabalin administered preoperatively is an efficient and safe agent for preemptive analgesia. Premedication with pregabalin reduces postoperative pain scores and total analgesic consumption without increasing sedation or other side effects in the postoperative period. KEYWORDS: premptive, pregabalin analgesia; morphine. INTRODUCTION:In postoperative period proper analgesia management increases patient's postoperative well-being and reduces development of complications that can result in an extended hospital stay and increased costs. (1) Acute pain after surgery has been as predictor of persistent pain after surgery and about 5-50% of patients experience persistent post-operative pain in different varieties of surgical operations. (2) Recent advances in the pathophysiology of pain have provided the possibility of prevention or reduction of excessive excitability of the central nervous system (CNS) associated with post-operative intensified pain. (3) Multimodal pain management modalities include the use of opioid analgesics, non-opioid analgesics and drugs from local anesthetics group applied using regional techniques (3) Advances in the molecular mechanisms has led to the development of multidimensional analgesia and using new pharmaceutical products on post-operative pain control. (4) It has been shown that nociceptive stimuli via afferent C fibers cause hyperexcitation in dorsal neurons of the spinal cord. The aim of the preemptive analgesia is to block postoperative pain by inhibiting this sensitization. Many different drugs such as paracetamol, lornoxicam, ketamine or gabapentin as well as regional blocks have been used for the purpose of preemptive analgesia. (5)(6)(7)(8)

Comparison of efficacy of oral pregabalin and oral paracetamol as pre-emptive analgesics in patients receiving spinal anaesthesia for lower limb surgeries

“…No significant difference was observed between the two groups regarding side effects during the first postoperative 24 hours (p>0.05)". 12 Time requirement of first rescue analgesia with group PG mean duration was of 4.3±1.2 hrs and group PA mean duration 3.3±1.1 hrs and p values < 0.001which statistically significant. It shows Pregabalin has better post-operative analgesia compared to Paracetamol.…”