Pregabalin can decrease acute pain and morphine consumption in laparoscopic cholecystectomy patients

Abstract

Background:Pregabalin has been used as an adjunct for the management of acute pain in laparoscopic cholecystectomy. This meta-analysis aimed to illustrate the efficacy and safety of pregabalin for pain management following laparoscopic cholecystectomy.Methods:In March 2017, a systematic computer-based search was conducted in PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, and Google databases. Data on patients prepared for laparoscopic cholecystectomy in studies that compared pregabalin versus placebo were retrieved. The primary endpoints were the visual analog scale (VAS) score with rest or mobilization at 6, 12, and 24 hours and total morphine consumption. The secondary outcomes were the morphine-related complications (i.e., nausea, vomiting, dizziness, somnolence, headache, pruritus, urine retention, respiratory depression, and blurred vision). Continuous outcomes were expressed as the weighted mean difference (WMD) with a corresponding 95% confidence interval (CI), and discontinuous outcomes were expressed as a risk ratio (RR) with a corresponding 95% CI.Results:Twelve clinical studies with 938 patients (gabapentin group = 536, control group = 402) were ultimately included in the meta-analysis. Pregabalin was associated with reduced pain scores with rest at 6, 12, and 24 hours, which corresponded to a reduction of 11.27 points at 6 hours, 9.46 points at 12 hours, and 3.99 points at 24 hours on a 100-point VAS. Moreover, pregabalin was associated with reduced pain scores with mobilization at 6, 12, and 24 hours, which corresponded to a reduction of 8.74 points, 5.80 points and 6.37 points at 6, 12, and 24 hours, respectively, on a 110-point VAS. Furthermore, pregabalin reduced the occurrence of nausea and vomiting. There were no significant differences in the occurrence of respiratory depression, pruritus, dizziness, blurred vision, and headache.Conclusions:Pregabalin was efficacious in the reduction of postoperative pain, total morphine consumption, and morphine-related complications following laparoscopic cholecystectomy. In addition, a high dose of pregabalin was more effective than a low dose. The dose of pregabalin differed across the studies, and the heterogeneity was large. More studies are needed to verify the optimal dose of pregabalin in laparoscopic cholecystectomy patients.

Perioperative Use of Gabapentinoids for the Management of Postoperative Acute Pain

“…22,23 Previous systematic reviews have weaknesses. First, most were designed to look at specific surgical populations [24][25][26][27][28][29][30][31][32][33] with often a limited sampling frame or a specific type of drugs [34][35][36][37][38][39][40] when pregabalin and gabapentin share the same mechanism of action and comparable pharmacologic properties. 41,42 Second, the concept of minimally important difference 43 for pain intensity was never considered in previous work, neither was the statistical reliability of the findings quantified.…”

Effect of preoperative gabapentin after transurethral prostate resection under general anesthesia

“…www.smj.org.sa Saudi Med J 2020; Vol. 41 (6) gabapentin group had significantly longer time to the first analgesic demand, fewer participants who required postoperative analgesia and fewer doses of tramadol administrated than the control group ( Table 2).…”

“…4 Various meta-analyses and systematic reviews report that preoperative gabapentin decreases pain intensity and analgesic demand on the first postoperative day. [4][5][6] The rationale behind analgesic effect of preoperative gabapentin is that antinociceptive treatment started before the surgical stimuli is more efficient in decreasing postoperative pain than treatment initiated in the early postoperative period, as it can reduce hyper sensitivity induced by the surgical procedures in central nerve system. 7 Gabapentin can easily attach to α-2-δ subunits of presynaptic voltage-gated calcium channels.…”

“…The doses between 300 and 1200 mg of gabapentin have been used for preoperative administration and well tolerated orally. [4][5][6] The dose of 600 mg has been found to be a proper dose for preoperative use. Larger dose may increase the occurrence of side effects, and smaller dose is likely related with inadequate effect.…”

“…The result is consistent with previous reports. 6 Study limitations. Only total consumption of tramadol for 48 hours is recorded, so our results cannot demonstrate if the analgesic sparing efficacy of gabapentin extends beyond the study period.…”