Pregabalin to improve postoperative recovery in bariatric surgery: a parallel, randomized, doubleblinded, placebo-controlled study

Abstract

PurposeObesity has been considered as a major public health problem in developed countries for which bariatric surgery has become an important treatment strategy. Postoperative pain, however, is a frequent problem in postoperative management. Pregabalin blocks the development of hyperalgesia and central pain sensitization. The objective of this randomized, placebo-controlled, double-blinded trial was to evaluate the effect of a single dose of preoperative pregabalin vs placebo on the quality of postoperative recovery in patients undergoing bariatric surgery.Patients and methodsA total of 70 patients undergoing abdominal gastroplasty were randomly assigned to receive oral pregabalin (75 mg) or an identical placebo 1 hour before surgery. The primary outcome was Quality of Recovery-40 (QoR-40) score at 24 hours. Secondary outcomes included opioid consumption and postoperative pain scores. P<0.05 was considered to indicate statistical significance.ResultsIn all, 60 of the 70 patients completed the study. The mean (SD) global recovery scores (QoR-40) 24 hours after surgery in the pregabalin and control groups were 183.7 (9) and 182.1 (12), respectively (mean difference=1.6, 95% CI –7.36 to 4.2, P=0.59). There was no significant difference in the total opioid consumption in the 24 hours following surgery between the two groups (pregabalin vs control=0.47×0.2; mean difference=0.26, 95% CI −0.24 to 0.77, P=0.3). There were no significant differences in nausea, vomiting, or time to postanesthesia care unit discharge between the two groups.ConclusionIn patients who underwent bariatric surgery, a single preoperative dose of pregabalin (75 mg) did not improve pain relief, quality of postoperative recovery, or reduction in opioid consumption.Clinical trial registrationhttp://www.ensaiosclinicos.gov.br (identifier: RBR-2g89x8).

Evaluation of Pregabaline Efficiency in Reducing Opioid Use and Pain in Post-Operating Patients Subject to Total Knee Arthroplasty Surgery

“…A Korean study with healthy patients showed no increase in adverse effects when combining tramadol with pregabalin Lee [37]. Similar results with the use of pregabalin for postoperative pain reduction were found by Martins [36], Zhang [31], Mathiesen [15] respectively after bariatric cholecystectomy and hip arthroplasty procedure. In a postoperative TKA study following pregabalin use for another 3 months no patient had a common adverse effect of pregabalin even though the study addressed an extensive list of endocrine, [35].…”

“…Again, it was shown that there was no improvement in the quality of postoperative patient recovery and not even pain reduction Martins Et Al. [36]. As the effectiveness of postoperative pain reduction has been demonstrated with dosages of 150mg and 300mg Singla et al [37] these interpretations become questionable.…”

Roux-in-Y Gastrojejunal Bypass: Which Anesthetic Technique Has Best Results?

“…Opioids continue to play an important role in controlling postoperative pain; however, they are not exempt from side effects, and a multimodal approach has been suggested to improve postoperative analgesia and, at the same time, mitigate these side effects 14 .…”

Perioperative Pain Management in Bariatric Anesthesia

“…Pregabalin is more widely studied as an adjuvant to improve perioperative pain management in bariatric anesthesia with mixed results. [ 22 ] Even if started in the postoperative period, gabapentin and pregabalin may increase sedation and potentiate opioid-induced respiratory depression, adversely impact sleep architecture, and impair balance and vision. Their use in the perioperative period should require a very careful assessment of the risk–benefit in patients after bariatric surgery, especially those with OSA.…”

“…Their use in the perioperative period should require a very careful assessment of the risk–benefit in patients after bariatric surgery, especially those with OSA. [ 21 22 ] Hence, the routine use of the gabapentinoids is not useful or justified in bariatric anesthesia unless the patient is already on them or develops acute hyperalgesia postoperatively.…”