A randomised controlled trial of peri‐operative pregabalin vs. placebo for video‐assisted thoracoscopic surgery

Konstantatos, Alex; Howard, William R; Story, David A; Mok, Louis Y H; Boyd, Dana; Chan, Matthew T. V.

doi:10.1111/anae.13292

Cited by 16 publications

(18 citation statements)

References 37 publications

(36 reference statements)

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“…1 Depending on the type of procedure, the reported incidence of chronic postsurgical pain ranges from 10% after Caesarean section to 30-50% after limb amputation. [2][3][4][5][6] Given that quality of life and physical activities are adversely affected, 4 7 8 a strategy that prevents chronic postsurgical pain is therefore highly desirable.…”

mentioning

confidence: 99%

Chronic postsurgical pain in the Evaluation of Nitrous Oxide in the Gas Mixture for Anaesthesia (ENIGMA)-II trial

Chan¹,

Peyton²,

Myles³

et al. 2016

British Journal of Anaesthesia

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mentioning

confidence: 99%

Chronic postsurgical pain in the Evaluation of Nitrous Oxide in the Gas Mixture for Anaesthesia (ENIGMA)-II trial

Chan¹,

Peyton²,

Myles³

et al. 2016

British Journal of Anaesthesia

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“…The literature search included 9 qualifying RCTs with 684 patients that met inclusion criteria (Figure 1). 15–23 Quality assessment of RCTs was presented in Figures 2 and 3. The characteristics of patients and interventions are presented in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…The characteristics of patients and interventions are presented in Table 1. One was conducted in multicenters,15 and others were conducted in a single center. All RCTs applied randomized strategies.…”

Section: Resultsmentioning

confidence: 99%

The efficacy of pregabalin for the management of acute and chronic postoperative pain in thoracotomy: a meta-analysis with trial sequential analysis of randomized-controlled trials

Liu²,

Zeng

et al. 2018

JPR

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PurposePregabalin is commonly used as an analgesic for neuropathic pain. But pregabalin as an adjunct to a multimodal analgesic regimen – although standard clinical protocol in some settings – has remained controversial. This meta-analysis was conducted to identify the efficacy of pregabalin for management of postoperative pain in thoracotomy.Materials and methodsPubmed, Embase, Cochrane, Web of Science, Springer, and Clinical Trial Register database were searched for randomized controlled trials (RCTs) of pregabalin in preventing postoperative pain in thoracotomy. Review Manager 5.3 and STATA 12.0 were selected to conduct the meta-analysis. Trial sequential analysis was used to control random errors and calculate the required information size.ResultsNine RCTs with 684 patients were included in our meta-analysis. Outcomes favoring pregabalin included less pain on a 0–10 scale on 1 day [mean difference (MD): −0.87; 95% CI: −1.55 to −0.19; P=0.01], 3 days (MD: −1.55; 95% CI: −1.93 to −1.18; P<0.00001), 1 month (MD: −1.58; 95% CI: −2.75 to −0.42; P=0.008), 3 months (MD: −1.69; 95% CI: −2.71 to −0.66; P=0.001) postoperatively, and less incidence of neuropathic pain (OR: 0.20; 95% CI: 0.05–0.91; P=0.04), less mean morphine consumption (MD: −5.03; 95% CI: −8.06 to −1.99; P=0.001), but more dizziness (OR: 3.33; 95% CI: 1.36–8.17; P=0.009), more drowsiness (OR: 8.61; 95% CI: 2.23–33.20; P=0.002), and less constipation (OR: 0.23; 95% CI: 0.09–0.59; P=0.002). There was no statistical differences in pain score on 7 days (MD:–0.77; 95% CI: −2.38 to 0.84; P=0.35), nausea (OR: 0.73; 95% CI: 0.42–1.26; P=0.26), and vomiting (OR: 0.83; 95% CI: 0.36–1.90; P=0.65).ConclusionPregabalin can prevent postoperative pain in thoracotomy and decrease incidence of neuropathic pain and morphine consumption. Pregabalin may be a valuable asset in management of acute and persistent postoperative pain in thoracotomy.

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“…Pregabalin shows no benefit on the incidence of CPOP when multiple surgical types are analyzed together 54 nor does it provide benefit when added to a spinal block plus celecoxib following THA 65 . Adding pregabalin to an epidural regimen following thoracotomy 69 or using it after video-assisted thoracoscopic surgery 70 may actually make the incidence of CPOP worse.…”

Section: Discussionmentioning

confidence: 99%

“…However, the pregabalin group reported less severe average pain, required fewer analgesics, and had less neuropathic pain than did the placebo group 69 . A 2016 trial of 300 mg pregabalin started 30 minutes before induction followed by 150 mg twice daily for 5 days showed a non-statistically significant increase in the incidence of CPOP after video-assisted thoracoscopic surgery 70 , whereas a 2016 trial of 40 mg intravenous parecoxib started 30 minutes before induction and then every 12 hours for 3 days, in addition to a thoracic epidural, decreased the incidence of CPOP after thoracotomy and video-assisted thoracoscopic surgery 71 .…”

Section: Preventionmentioning

confidence: 98%

Chronic postoperative pain: recent findings in understanding and management

Correll

2017

F1000Res

111

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Chronic postoperative pain is a poorly recognized potential outcome from surgery. It affects millions of patients every year, with pain lasting for months to years, resulting in patient suffering and ensuing economic consequences. The operations with the highest incidence of chronic postoperative pain are amputations, thoracotomies, cardiac surgery, and breast surgery. Other risk factors include preoperative pain, psychological factors, demographics, and the intensity of acute postoperative pain. Attempts to prevent chronic postoperative pain have often led to debatable results. This article presents data from recently published studies examining the incidence, risk factors, mechanisms, treatment options, and preventive strategies for chronic postoperative pain in adults. In summary, many of the previously identified risk factors for chronic postoperative pain have been confirmed and some novel ones discovered, such as the importance of the trajectory of acute pain and the fact that catastrophizing may not always be predictive. The incidence of chronic postoperative pain hasn’t changed over time, and there is limited new information regarding an effective preventive therapy. For example, pregabalin may actually cause more harm in certain surgeries. Further research is needed to demonstrate whether multimodal analgesic techniques have the best chance of significantly reducing the incidence of chronic postoperative pain and to determine which combination of agents is best for given surgical types and different patient populations.

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A randomised controlled trial of peri‐operative pregabalin vs. placebo for video‐assisted thoracoscopic surgery

Abstract: SummaryWe allocated 52 participants to oral pregabalin 300 mg and 48 participants to placebo tablets before thoracoscopic surgery and for five postoperative days

Cited by 16 publications

References 37 publications

Chronic postsurgical pain in the Evaluation of Nitrous Oxide in the Gas Mixture for Anaesthesia (ENIGMA)-II trial

Chronic postsurgical pain in the Evaluation of Nitrous Oxide in the Gas Mixture for Anaesthesia (ENIGMA)-II trial

The efficacy of pregabalin for the management of acute and chronic postoperative pain in thoracotomy: a meta-analysis with trial sequential analysis of randomized-controlled trials

Chronic postoperative pain: recent findings in understanding and management

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