The preemptive effects of oral pregabalin on perioperative pain management in lower limb orthopedic surgery: a systematic review and meta-analysis

Abstract

Background To systematically review the literature and provide a comprehensive understanding of the preemptive effects of oral pregabalin on perioperative pain management in lower limb orthopedic surgery. Method We searched three electronic databases for randomized controlled trials comparing the results of preoperative pregabalin and placebo in patients undergoing lower limb orthopedic surgery. Data analyses were conducted using RevMan 5.4. Results Twenty-one randomized controlled trials met our inclusion criteria. The cumulative opioid consumption within 24 and 48 h postoperatively in the pregabalin group was significantly less than that in the placebo group. The pooled static pain intensity at all time points within the first day was significantly lower in the pregabalin group than in the placebo group. Lower dynamic pain intensity at 48 h was detected in the pregabalin group than in the placebo group. Meanwhile, pregabalin led to a lower incidence of nausea but appeared to be associated with a higher incidence of dizziness and sedation. Subgroup analyses showed that no difference was detected between subgroups stratified by dosing regimen or pregabalin dose in the results of opioid consumption, pain intensity and incidence of complications. Conclusion This meta-analysis supports the use of pregabalin preoperatively in patients undergoing lower limb orthopedic surgery. However, it was wary of the resulting increase in dizziness and sedation. There is no evidence to support the continued use of pregabalin postoperatively or using more than 150 mg of pregabalin per day. Trial registration: This study was registered on 09 November 2021 with INPLASY (registration number: INPLASY2021110031).

A Meta-Analysis Showing the Quantitative Evidence Base of Preemptive Pregabalin for Postoperative Pain from Cancer-Related Surgery

“…There has been considerable research on pregabalin in reducing pain intensity, morphine consumption, and side effects after surgery [ 17 , 19 , 57 , 58 , 59 , 60 ]. We had similar results with a recent review described by Chang et al [ 61 , 62 ] for pain severity scores postoperatively in breast cancer surgery when pregabalin was administrated.…”

“…Previous studies and systematic reviews have reported the effect of pregabalin as a perioperative adjuvant analgesic in reducing postoperative acute pain and adverse effects by reducing the opioid dose and pain scores [ 17 , 18 , 19 ]. However, there is only a small amount of evidence for preemptive pregabalin in patients undergoing cancer-related surgery.…”

The effect of pregabalin on postoperative pain after anterior cruciate ligament reconstruction: A systematic review of randomized clinical trials

“…30 The result of this study was consistent with Dong et al study which indicated that preoperative pregabalin administration could decrease the cumulative morphine consumption at 24 hours (95% CI −1.17 to −0.78; p < 0.001) and VAS at rest at 24 hours (95% CI −12.57 to −3.71; p < 0.001) and 48 hours (95% CI −11.65 to −3.02; p < 0.001) following total knee arthroplasty. 32 Furthermore, a meta-analysis by Chen et al 33 supported the use of pregabalin before surgery in patients undergoing orthopedic lower limb surgery. In this study, pregabalin administration was associated with lower opioid consumption 24 hours (95% CI [−52.32, −16.63], p = 0.0002), lower dynamic pain intensity 48 hours (95% CI [−0.88, −0.07], p = 0.02) and lower static pain intensity 2 hours (95% CI [−0.50, −0.02], p = 0.04) after surgery.…”

“…30 The result of this study was consistent with Dong et al study which indicated that preoperative pregabalin administration could decrease the cumulative morphine consumption at 24 hours (95% CI À1.17 to À0.78; p < 0.001) and VAS at rest at 24 hours (95% CI À12.57 to À3.71; p < 0.001) and 48 hours (95% CI À11.65 to À3.02; p < 0.001) following total knee arthroplasty. 32 Furthermore, a meta-analysis by Chen et al 33 35 evaluated pain 1 and 3 months after open heart surgery and showed that pain during movement at 3 months postoperatively in patients treated with 150 mg pregabalin preoperatively and 75 mg twice a day postoperatively for 5 days is significantly lower (p < 0.05) than patients who did not receive pregabalin. Finally, Agarwal et al 36 reported that pregabalin had a significant effect on reducing pain after laparoscopic cholecystectomy compared to placebo (p < 0.05).…”

Pain treatment and prophylaxis on pain

“…The evidence of analgesic effect from gabapentin or pregabalin in the postoperative setting is generally robust, but the effect on top of the basic four (see above) is usually minor and the adverse effects of sedation and dizziness may delay discharge and cause falls after discharge [26,55 ▪ ]. Thus, they should be reserved for individual cases where much pain is expected.…”