The Korean Journal of Pain

  • 제24권1호
  • /
  • Pages.22-30
  • /
  • 2011
  • /
  • 2005-9159(pISSN)
  • /
  • 2093-0569(eISSN)
대한통증학회 (The Korean Pain Society)
권호 표지
DOI QR코드

DOI QR Code

A Randomised, Placebo-controlled Trial of the Effects of Preoperative Pregabalin on Pain Intensity and Opioid Consumption following Lumbar Discectomy

  • Hegarty, Dominic A. (Department of Anaesthesia, Intensive Care & Pain Medicine, Cork University Hospital) ;
  • Shorten, George D. (Department of Anaesthesia, Intensive Care & Pain Medicine, Cork University Hospital)
  • 투고 : 2010.12.07
  • 심사 : 2011.01.21
  • 발행 : 2011.03.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Background: Pregabalin has been shown to have analgesic effect in acute pain models. The primary objective was to examine the efficacy a single dose of pregabalin, would have on morphine consumption following lumbar discectomy. Methods: With ethical approval a randomized, placebo-controlled prospective trial was undertaken in 32 patients (ASA I-II, 18-65 years) with radicular low back pain for > 3 months undergoing elective lumbar discectomy. Patients received either oral pregabalin 300 mg (PG Group) or placebo (C Group) one hour before surgery. Pain intensity, the accumulative morphine consumption and adverse effects were recorded for 24 hours following surgery. Functional, psychological and quantitative sensory testing were also assessed. Results: Fourteen patients out of the 32 recruited were randomized to receive pregabalin. Morphine consumption was reduced (absolute difference of 42.3%) between groups with medium effect size. (Mann-Whitney; U =52.5, z-score= 2.84, P = 0.004, r = 0.14). This was not associated with a significant difference in the incidence of adverse effects between the two groups. The median pain intensity (VAS) on movement was not significantly different between groups. Conclusions: A single pre-operative dose of pregabalin (300 mg) did not result in a reduction in pain intensity compared to placebo in this patient cohort but the significant reduction in morphine consumption suggests that a fixed peri-operative dosing regime warrants investigation.

키워드

참고문헌

  1. Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg 2003; 97: 534-40. https://doi.org/10.1213/01.ANE.0000068822.10113.9E
  2. Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet 2006; 367: 1618-25. https://doi.org/10.1016/S0140-6736(06)68700-X
  3. Buvanendran A, Kroin JS, Kari M, Tuman KJ. Can a single dose of 300 mg of pregabalin reach acute antihyperalgesic levels in the central nervous system? Reg Anesth Pain Med 2010; 35: 535-8. https://doi.org/10.1097/AAP.0b013e3181fa6b7a
  4. Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg 2002; 183: 630-41. https://doi.org/10.1016/S0002-9610(02)00866-8
  5. Hill CM, Balkenohl M, Thomas DW, Walker R, Mathe H, Murray G. Pregabalin in patients with postoperative dental pain. Eur J Pain 2001; 5: 119-24.
  6. Paech MJ, Goy R, Chua S, Scott K, Christmas T, Doherty DA. A randomized, placebo-controlled trial of preoperative oral pregabalin for postoperative pain relief after minor gynecological surgery. Anesth Analg 2007; 105: 1449-53. https://doi.org/10.1213/01.ane.0000286227.13306.d7
  7. Nemethy M, Paroli L, Williams-Russo PG, Blanck TJ. Assessing sedation with regional anesthesia: inter-rater agreement on a modified Wilson sedation scale. Anesth Analg 2002; 94: 723-8. https://doi.org/10.1097/00000539-200203000-00045
  8. Melzack R. The McGill pain questionnaire: from description to measurement. Anesthesiology 2005; 103: 199-202. https://doi.org/10.1097/00000542-200507000-00028
  9. Ostelo RW, de Vet HC, Knol DL, van den Brandt PA. 24-item Roland-Morris disability questionnaire was preferred out of six functional status questionnaires for post-lumbar disc surgery. J Clin Epidemiol 2004; 57: 268-76. https://doi.org/10.1016/j.jclinepi.2003.09.005
  10. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67: 361-70. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x
  11. Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the hospital anxiety and depression scale. An updated literature review. J Psychosom Res 2002; 52: 69-77. https://doi.org/10.1016/S0022-3999(01)00296-3
  12. Sullivan MJ, Lynch ME, Clark AJ. Dimensions of catastrophic thinking associated with pain experience and disability in patients with neuropathic pain conditions. Pain 2005; 113: 310-5. https://doi.org/10.1016/j.pain.2004.11.003
  13. Agarwal A, Gautam S, Gupta D, Agarwal S, Singh PK, Singh U. Evaluation of a single preoperative dose of pregabalin for attenuation of postoperative pain after laparoscopic cholecystectomy. Br J Anaesth 2008; 101: 700-4. https://doi.org/10.1093/bja/aen244
  14. Taylor CP. Mechanisms of analgesia by gabapentin and pregabalin--calcium channel alpha2-delta [Cavalpha2-delta] ligands. Pain 2009; 142: 13-6. https://doi.org/10.1016/j.pain.2008.11.019
  15. Tuchman M, Barrett JA, Donevan S, Hedberg TG, Taylor CP. Central sensitization and Ca(V)${\alpha}_2{\delta}$ ligands in chronic pain syndromes: pathologic processes and pharmacologic effect. J Pain 2010; 11: 1241-9. https://doi.org/10.1016/j.jpain.2010.02.024
  16. Jokela R, Ahonen J, Tallgren M, Haanpaa M, Korttila K. A randomized controlled trial of perioperative administration of pregabalin for pain after laparoscopic hysterectomy. Pain 2008; 134: 106-12. https://doi.org/10.1016/j.pain.2007.04.002
  17. Mathiesen O, Jacobsen LS, Holm HE, Randall S, Adamiec-Malmstroem L, Graungaard BK, et al. Pregabalin and dexamethasone for postoperative pain control: a randomized controlled study in hip arthroplasty. Br J Anaesth 2008; 101: 535-41. https://doi.org/10.1093/bja/aen215
  18. Buvanendran A, Kroin JS, Della Valle CJ, Kari M, Moric M, Tuman KJ. Perioperative oral pregabalin reduces chronic pain after total knee arthroplasty: a prospective, randomized, controlled trial. Anesth Analg 2010; 110: 199-207. https://doi.org/10.1213/ANE.0b013e3181c4273a
  19. Straube S, Derry S, McQuay HJ, Moore RA. Enriched enrollment: definition and effects of enrichment and dose in trials of pregabalin and gabapentin in neuropathic pain. A systematic review. Br J Clin Pharmacol 2008; 66: 266-75. https://doi.org/10.1111/j.1365-2125.2008.03200.x

피인용 문헌

  1. The Effect of Preoperative Pregabalin on Postoperative Nausea and Vomiting vol.123, pp.5, 2016, https://doi.org/10.1213/ANE.0000000000001404
  2. Benefit and harm of pregabalin in acute pain treatment: a systematic review with meta-analyses and trial sequential analyses vol.119, pp.4, 2017, https://doi.org/10.1093/bja/aex227
  3. Duloxetine as an Analgesic Reduces Opioid Consumption After Spine Surgery vol.33, pp.10, 2017, https://doi.org/10.1097/AJP.0000000000000471
  4. Preoperative use of pregabalin for acute pain in spine surgery vol.96, pp.11, 2017, https://doi.org/10.1097/MD.0000000000006129
  5. A meta-analysis of the preoperative use of gabapentinoids for the treatment of acute postoperative pain following spinal surgery vol.96, pp.37, 2017, https://doi.org/10.1097/MD.0000000000008031
  6. Effects of methylene blue on postoperative low-back pain and functional outcomes after lumbar open discectomy: a triple-blind, randomized placebo-controlled trial pp.1547-5654, 2016, https://doi.org/10.3171/2015.3.SPINE141172
  7. Pregabalin in Neuropathic Pain: Evidences and Possible Mechanisms vol.12, pp.1, 2011, https://doi.org/10.2174/1570159x1201140117162802
  8. Perioperative use of pregabalin for acute pain-a systematic review and meta-analysis vol.156, pp.7, 2011, https://doi.org/10.1097/j.pain.0000000000000173
  9. Effects of a single dose of preoperative pregabalin and gabapentin for acute postoperative pain: a network meta-analysis of randomized controlled trials vol.11, pp.None, 2018, https://doi.org/10.2147/jpr.s170810
  10. Risk factors of postoperative low back pain for low-grade isthmic spondylolisthesis: a retrospective study vol.48, pp.3, 2011, https://doi.org/10.1177/0300060519890791
  11. Perioperative Use of Gabapentinoids for the Management of Postoperative Acute Pain vol.133, pp.2, 2011, https://doi.org/10.1097/aln.0000000000003428
  12. Effect of pregabalin on nociceptive thresholds and immune responses in a mouse model of incisional pain vol.34, pp.2, 2011, https://doi.org/10.3344/kjp.2021.34.2.185