Three -Agent Preemptive Analgesia, Pregabalin-Acetaminophen-Naproxen, in Laparotomy for Cancer: A Randomized Clinical Trial

Abstract

BackgroundPain management after abdominal surgery is a critical issue in cancer patients undergoing laparotomy. Opioid analgesics commonly used postoperatively have significant side effects and can postpone restoring normal life. Administration of analgesics before the surgery by inhibiting pain cascades may be an effective method for more efficient pain control.ObjectivesThis study aimed to investigate the effect of the preemptive use of oral pregabalin-acetaminophen-naproxen on pain control and morphine consumptions in cancer patients undergoing laparotomy.Patients and MethodsA total of 40 cancer patients scheduled for open abdominal surgery were randomized into the two groups. one group received combination of pregabalin 150 mg, acetaminophen 1 g and naproxen 250 mg (the PAN group) an hour before laparotomy. Following the surgery, morphine was administered on a protocolized schedule based on patients’ demand for pain control. Postoperative pain level was assessed using universal pain assessment tool (UPAT) at 0, 2, 4, 6, 12, 24 and 48 hours after the operation. The postoperative morphine dose and complications were noted. Data were analyzed using SPSS version 16.ResultsPatients in the PAN group had significantly lower UPAT scores at 0, 2, 4, 6, 12, 24 and 48 hours after the surgery than those in the control group (P = 0.008, 0.021, 0.008, 0.047, 0.004, 0.001, and 0.001). The mean dose of postoperative morphine consumption in the PAN group was 37% less than the control group (P = 0.001). The complications were not significantly different between the two groups.ConclusionsPreemptive use of pregabalin-acetaminophen-naproxen decreases intensity of pain and morphine consumption in the cancer patients after laparotomy without significant complications.

Preemptive Analgesia with a Second Dose of Pregabalin, Acetaminophen, Naproxen, and Dextromethorphan: A Comparative Clinical Trial in Major Surgeries

“…The inability to assess the incidence of chronic pain due to time constraints was one of the limitations of the current study. In summary, several agents are examined for preventive analgesia (44). Signif-icant opioid sparing and a decreased pain score following preemptive gabapentin was also reported in several other studies (46-48).…”

“…Moreover, it improved sleep quality during the first postoperative night (43). In another study aimed at investigating the effect of prophylactic use of oral pregabalin-acetaminophen-naproxen on pain control and morphine usage in patients who had undertaken laparotomy, patients in the PAN group (pregabalin 150 mg, acetaminophen 1 g, and naproxen 250 mg) experienced lower pain and the morphine use was also significantly lower than the control group (44). A previous study on the effect of prophylactic analgesia in women undergoing abdominal hysterectomy suggested the higher satisfaction scores of patients who received a combination of gabapentin and paracetamol compared to those who received gabapentin alone.…”

Postoperative pain management in non-traumatic emergency general surgery: WSES-GAIS-SIAARTI-AAST guidelines

“…Different efficacy can be assessed according to the timing in the administration of acetaminophen, in the context of multimodal analgesia, as a preemptive analgesia. Acetaminophen used in multimodal and preemptive therapy (1 g before laparotomy with naproxen 250 mg and pregabalin 150 mg) was associated with a reduction of opiate side effects as well as a fewer length of stay, lower opioid-related complication rates, and lower costs compared to patients who had not received this treatment [48].…”

“…47 Italy. 48 ICU Department, Maggiore Hospital, Bologna, Italy. 49 ICU Department, P. Giaccone Hospital, Palermo, Italy.…”

Effect of routine abdominal drainage on postoperative pain after uncomplicated laparoscopic cholecystectomy for cholelithiasis: A randomised controlled trial

“…Different methods have been introduced for pain-relieving after surgical procedures [ 1 ]. Opioids are the most common postoperative analgesic agent, which causes various complications in patients, including exacerbation of ileus and bowel dysfunction after abdominal surgeries [ 2 ]. Thus, there is an increasing need for pain-relieving methods for postoperative pain, particularly in abdominal surgeries.…”