Impact of pregabalin on early phase post-thoracotomy pain compared with epidural analgesia

Abstract

Background: The purpose of this randomized study was to compare the effects of pregabalin with epidural analgesia on early phase post-thoracotomy pain. Methods: This study was conducted on 90 adult patients who underwent thoracotomy. Patients were randomly divided into two groups, an epidural analgesia group, where 45 patients received 0.2% ropivacaine hydrochloride and fentanyl through a thoracic epidural catheter, and a pregabalin group, where 45 patients received 75 mg pregabalin orally twice daily. Both groups were also administered orally with celecoxib along with each treatment. Numerical rating scale (NRS) and sleep interference rate (SIR) were evaluated on the first day, third day, and fifth day after surgery. Anesthetic induction time, operation time, recovery time, the use of additional analgesic drugs and adverse effects were also examined. Results: NRS and SIR were significantly lower in the pregabalin group at all time points (P<0.05). The number of patients requiring additional analgesic drugs within 24 hours after surgery showed no difference between the two groups; however, the number was significantly decreased in the pregabalin group after post-operative day 1 (P<0.001). Adverse effects including pneumonia, dysuria, constipation and nausea were identified among many patients in the epidural analgesia group (P<0.05). Operation time and recovery time were the same for both groups, while the epidural analgesia group showed a significantly longer anesthetic induction time (P<0.001).Conclusions: Pregabalin is considered to be a safe and effective treatment method which is an alternative to epidural analgesia for acute post-thoracotomy pain.

Pregabalin as an analgesic option for patients undergoing thoracotomy: cost analysis of pregabalin versus epidural analgesia for post-thoracotomy pain relief

“…The lower costs for surgical materials and medications reflect the non-use of items needed only for epidural analgesia such as catheters, needles, and local anesthetic agents. The lower costs for anesthetic management are attributed not only to the absence of epidural analgesia, but also to the shortened anesthesia induction time, which was shown in our previous study (15). These lower costs did not lead to lower total hospitalization costs; however, considering increasing healthcare expenditures and limited healthcare resources in Japan, it is important to restrain these fee-for-service-based costs.…”

“…The methods of the RCT were published previously (15). Briefly, we recruited patients aged 20-80 years undergoing thoracotomy at Teikyo University Hospital if they met all the inclusion criteria and none of the exclusion criteria.…”

“…We previously conducted a randomized controlled trial (RCT) to evaluate the effects of pregabalin on acute post-thoracotomy pain (15). Results showed that patients receiving pregabalin reported significantly lower pain and sleep interference rates at 1, 3, and 5 postoperative days than did those receiving epidural analgesia.…”

Ultrasound Guided Transversus Thoracic Plane block, Parasternal block and fascial planes hydrodissection for internal mammary post thoracotomy pain syndrome

“…Since a neuropathic component often occurs, it must be treated with drugs used as first‐line therapy and that can be useful to reduce the PTPS symptoms, so tricyclic antidepressants and serotonine‐noradrenaline reuptake inhibitors are the most useful antidepressant drugs in this scenario as they act by potentiating the activity of the descending inhibitory pathways from the brainstem to the dorsal horn of the spinal cord (Fornasari, ). Pregabalin has also been successfully used for PTPS as it binds the Ca channels in nerve presynapses, suppressing the release of neurotransmitters and resulting in an analgesic effect (Matsutani et al., ).…”

Improving postoperative pain management after video-assisted thoracic surgery lung resection contributes to enhanced recovery, but guidelines are still lacking

“…Systemic opioids are associated with side effects, such as gastrointestinal dysfunction, and should be administered through a patient-controlled device (PCA), to account for interindividual pharmacokinetic and pharmacodynamic variability. Recently, pregabalin (16) and buprenorphine (17) have been suggested to reduce either postoperative hyperalgesia or unwanted side effects. Peripheral anesthetic blockades include paravertebral block, intercostal nerve local anesthetic infusion, and other anesthetic blocks ( Table 1).…”