A Randomised, Placebo-controlled Trial of the Effects of Preoperative Pregabalin on Pain Intensity and Opioid Consumption following Lumbar Discectomy
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
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.
Abstract
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.
참고문헌 (19)
- Apfelbaum JL, "Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged", Anesth Analg, 97, pp.534~540 (2003)
- Kehlet H, "Persistent postsurgical pain: risk factors and prevention", Lancet, 367, pp.1618~1625 (2006)
- Buvanendran A, "Can a single dose of 300 mg of pregabalin reach acute antihyperalgesic levels in the central nervous system", Reg Anesth Pain Med, 35, pp.535~538 (2010)
- Kehlet H, "Multimodal strategies to improve surgical outcome", Am J Surg, 183, pp.630~641 (2002)
- Hill CM, "Pregabalin in patients with postoperative dental pain", Eur J Pain, 5, pp.119~124 (2001)
- Paech MJ, "A randomized, placebo-controlled trial of preoperative oral pregabalin for postoperative pain relief after minor gynecological surgery", Anesth Analg, 105, pp.1449~1453 (2007)
- Némethy M, "Assessing sedation with regional anesthesia: inter-rater agreement on a modified Wilson sedation scale", Anesth Analg, 94, pp.723~728 (2002)
- Melzack R, "The McGill pain questionnaire: from description to measurement", Anesthesiology, 103, pp.199~202 (2005)
- Ostelo RW, "24-item Roland-Morris disability questionnaire was preferred out of six functional status questionnaires for post-lumbar disc surgery", J Clin Epidemiol, 57, pp.268~276 (2004)
- Zigmond AS, "The hospital anxiety and depression scale", Acta Psychiatr Scand, 67, pp.361~370 (1983)
- Bjelland I, "The validity of the hospital anxiety and depression scale. An updated literature review", J Psychosom Res, 52, pp.69~77 (2002)
- Sullivan MJ, "Dimensions of catastrophic thinking associated with pain experience and disability in patients with neuropathic pain conditions", Pain, 113, pp.310~315 (2005)
- Agarwal A, "Evaluation of a single preoperative dose of pregabalin for attenuation of postoperative pain after laparoscopic cholecystectomy", Br J Anaesth, 101, pp.700~704 (2008)
- ligands, "Pain", 2009, 13~16
- Tuchman M, "Central sensitization and Ca(V)α2 δ ligands in chronic pain syndromes: pathologic processes and pharmacologic effect", J Pain, 11, pp.1241~1249 (2010)
- Jokela R, "A randomized controlled trial of perioperative administration of pregabalin for pain after laparoscopic hysterectomy", Pain, 134, pp.106~112 (2008)
- Mathiesen O, "Pregabalin and dexamethasone for postoperative pain control: a randomized controlled study in hip arthroplasty", Br J Anaesth, 101, pp.535~541 (2008)
- Buvanendran A, "Perioperative oral pregabalin reduces chronic pain after total knee arthroplasty: a prospective, randomized, controlled trial", Anesth Analg, 110, pp.199~207 (2010)
- Straube S, "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, 66, pp.266~275 (2008)