Preoperative pregabalin has no effect on intraoperative neurophysiological monitoring in adolescents undergoing posterior spinal fusion for spinal deformities: a double-blind, randomized, placebo-controlled clinical trial

Helenius, Linda; Puhakka, Antti; Manner, Tuula; Pajulo, Olli; Helenius, Ilkka

doi:10.1007/s00586-017-5396-9

Cited by 5 publications

(5 citation statements)

References 22 publications

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“…Neurophysiological measurements were done every 20 min and at specific time points. In order to evaluate the safety of the study intervention, a data analysis of the neurophysiological measurements was performed after recruitment of the first 31 patients and the results were published 17 .…”

Section: Methodsmentioning

confidence: 99%

Preemptive Pregabalin in Children and Adolescents Undergoing Posterior Instrumented Spinal Fusion

Helenius

Oksanen

Lastikka

et al. 2019

The Journal of Bone and Joint Surgery

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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.

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Section: Methodsmentioning

confidence: 99%

Preemptive Pregabalin in Children and Adolescents Undergoing Posterior Instrumented Spinal Fusion

Helenius

Oksanen

Lastikka

et al. 2019

The Journal of Bone and Joint Surgery

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“…74,[91][92][93][94] Studies evaluating the use of gabapentinoids as neuromodulatory adjuvants show conflicting results supporting and refuting its efficacy. [95][96][97] Studies differed in doses used, time of use, and so forth. Documentation of increased side effects, such as sedation and dizziness, as well as lack of benefit in a meta-analysis evaluating preoperative use of gabapentinoids (in adults) point to insufficient evidence for its use.…”

Section: Error Trap 4: Failure To Optimize Postprocedures Recovery Us...mentioning

confidence: 99%

“…Use of nonopioid adjuvants such as acetaminophen and ketorolac (0.5 mg/kg IV dose every 6 h for six doses) have been shown to decrease opioid use and LOS, without increased risk for adverse effects; however, there are no studies demonstrating the optimal route of administration or optimal number of doses for acetaminophen after spine fusion 74,91–94 . Studies evaluating the use of gabapentinoids as neuromodulatory adjuvants show conflicting results supporting and refuting its efficacy 95–97 . Studies differed in doses used, time of use, and so forth.…”

Section: Introductionmentioning

confidence: 99%

Error traps and preventative strategies for adolescent idiopathic scoliosis spinal surgery

Hammon,

Chidambaran,

Templeton

et al. 2023

Pediatric Anesthesia

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Anesthesia for posterior spinal fusion for adolescent idiopathic scoliosis remains one of the most common surgeries performed in adolescents. These procedures have the potential for significant intraprocedural and postoperative complications. The potential for pressure injuries related to prone positioning must be understood and addressed. Additionally, neuromonitoring remains a mainstay for patient care in order to adequately assess patient neurologic integrity and alert the providers to a reversible action. As such, causes of neuromonitoring signal loss must be well understood, and the provider should have a systematic approach to signal loss. Further, anesthetic design must facilitate intraoperative wake‐up to allow for a definitive assessment of neurologic function. Perioperative bleeding risk is high in posterior spinal fusion due to the extensive surgical exposure and potentially lengthy operative time, so the provider should undertake strategies to reduce blood loss and avoid coagulopathy. Pain management for adolescents undergoing spinal fusion is also challenging, and inadequate analgesia can delay recovery, impede patient/family satisfaction, increase the risk of chronic postsurgical pain/disability, and lead to prolonged opioid use. Many of the significant complications associated with this procedure, however, can be avoided with intentional and evidence‐based approaches covered in this review.

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“…In order to evaluate the safety of the study intervention, a data analysis of the neurophysiological measurements was performed after recruitment of the first 31 patients and the results were published. 18 Before surgery, all patients were instructed on the use of the patient-controlled analgesia (PCA) system (CADD-Legacy PCA Pump, Model 6300; Smiths Medical). Standard oxycodone PCA was initiated in the postoperative intensive care unit (ICU), with no basal infusion.…”

Section: Perioperative Managementmentioning

confidence: 99%

“…Neurophysiological measurements were made every 20 minutes and at specific time points. In order to assess the safety of the study intervention, neurophysiological data for the first 31 patients were analyzed following recruitment, and these results were published 19 .…”

Section: Perioperative Managementmentioning

confidence: 99%

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

Helenius

Yrjälä

Oksanen

et al. 2021

Journal of Bone and Joint Surgery

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Surgical correction of spinal deformities is major surgery with extensive manipulation of the spine and neural elements. Persistent postsurgical pain affects the patients` quality of life and can also cause financial burden for families and community. We aimed to investigate the effects of perioperative pregabalin on the incidence of persistent pain after instrumented spinal fusion. Methods:The study design was a randomized, double-blind and placebo-controlled single center clinical trial. Adolescents and children aged 10 -21 years, with a spinal deformity scheduled for pedicle screw instrumentation and fusion were randomized in pregabalin or placebo group. The study subjects received preoperatively and five days after surgery pregabalin 2 mg/kg or placebo twice daily. Duration of follow-up was 2 years. The primary outcomes were cumulative oxycodone consumption during the first 48 postoperative hours and the incidence of persistent postsurgical pain during 2-year follow-up. Results:Out of 77 eligible patients 64 were enrolled in the study with all patients completing 2-year follow-up. Thirty-three patients were randomized into pregabalin group and 31 patients into placebo group. There was no statistically significant difference in the cumulative 48-hour oxycodone consumption between the study groups. The SRS-24 pain domain score showed a significant improvement from a mean value of 3.8 in both groups to 4.3 in the pregabalin and 4.0 in the placebo group during the 2-year FU with no differences between the study groups at any time point (p=0.317). The SRS-24 total scores were similar in the study groups (p=0.678). Back pain on a visual analogue scale improved significantly from preoperative 3 value during the two-year follow-up (p=0.0011) with no significant differences at any time point (preoperative, 6-month, 1 year and 2 year). Conclusions:Perioperative pregabalin does not reduce the postoperative opioid consumption nor the incidence of persistent postsurgical pain among adolescents after instrumented posterior spinal fusion for spinal deformities.

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Preoperative pregabalin has no effect on intraoperative neurophysiological monitoring in adolescents undergoing posterior spinal fusion for spinal deformities: a double-blind, randomized, placebo-controlled clinical trial

Abstract: I.

Cited by 5 publications

References 22 publications

Preemptive Pregabalin in Children and Adolescents Undergoing Posterior Instrumented Spinal Fusion

Preemptive Pregabalin in Children and Adolescents Undergoing Posterior Instrumented Spinal Fusion

Error traps and preventative strategies for adolescent idiopathic scoliosis spinal surgery

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

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