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

Abstract

Background: This study examined whether a perioperative regimen of pregabalin added to celecoxib improved pain scores and functional outcomes postdischarge up to 3 months after total hip arthroplasty (primary outcome) and acute postoperative pain and adverse effects (secondary outcomes). Methods: One hundred and eighty-four patients were enrolled in a randomized, double-blind, placebo-controlled study. Two hours before receiving a spinal anaesthetic and undergoing surgery, patients received celecoxib 400 mg p.o. and were randomly assigned to receive either pregabalin 150 mg p.o. or placebo p.o. After surgery, patients received pregabalin 75 mg or placebo twice daily in hospital and for 7 days after discharge. Patients also received celecoxib 200 mg every 12 h for 72 h and morphine i.v. patient-controlled analgesia for 24 h. Pain and function were assessed at baseline, 6 weeks, and 3 months after surgery. Results: There was no difference between groups in physical function or incidence and intensity of chronic pain 3 months after total hip arthroplasty. The pregabalin group used less morphine [mean (): 39.85 (28.1) mg] than the placebo group [54.01 (31.2) mg] in the first 24 h after surgery (P<0.01). Pain scores were significantly lower in the pregabalin group vs the placebo group on days 1-7 after hospital discharge, and the pregabalin group required less adjunctive opioid medication (Percocet) 1 week after hospital discharge (P<0.05). Conclusions: Perioperative administration of pregabalin did not improve pain or physical function at 6 weeks or 3 months after total hip arthroplasty. Perioperative administration of pregabalin decreased opioid consumption in hospital and reduced daily pain scores and adjunct opioid consumption for 1 week after discharge.

The effects of pregabalin and adductor canal block on postoperative pain in arthroscopic anterior cruciate ligament reconstruction

“…are preferred in acute pain, but higher doses have been associated with more adverse effects. A few studies have shown that a single preoperative oral dose of pregabalin (150 mg) can reduce postoperative pain and adverse effects in patients undergoing orthopaedic surgeries, as well as other surgeries [4,10,11]. In this study we also used the lowest effective dose of preoperative pregabalin (150 mg), which was similarly effective as doses used in the literature.…”

“…Several studies have shown that postoperative pain could persist for 2 to 6 weeks after discharge, and this could limit patient participation in daily activities [4]. Additionally, poorly controlled postoperative pain may lead to chronic pain [25].…”

“…Optimal analgesia facilitates early rehabilitation and mobilization, improves functional recovery, reduces postoperative morbidity, and increases patient satisfaction after anterior cruciate ligament reconstruction (ACLR) [1,3]. Multimodal analgesia using opioids and a variety of other analgesics is recommended for the management of acute pain after knee surgery [4].…”

“…Pregabalin is a structural analogue of γ-aminobutyric acid (GABA) acting on the α2δ subunit of voltagedependent calcium channels. Pregabalin is frequently used as a part of neuropathic and postoperative pain management [4]. Previous studies demonstrated that preoperative pregabalin reduced opioid consumption during the 24-h postoperative period in patients who received spinal or general anaesthesia [5][6][7][8][9][10][11].…”

Pharmachologic treatment of acute postoperative pain: A clinical practice guideline of The Turkish Society of Algology

“…Gabapentin ve pregabalin multimodal analjezinin bir parçası olarak postoperatif opioid gereksinimini azaltmaktadırlar. [50,51] Preoperatif tek doz ile bu etki sağlanabilir. Anksiyolitik etkileri ek avantajlarıdır.…”