Management of postoperative pain after Lumbar surgery—pregabalin for one day and 14 days—a randomized, triple-blinded, placebo-controlled study

Zarei, Mohammad; Najafi, Arvin; Mansouri, Pejman; Sadeghi-Yazdankhah, Sadaf; Saberi, Houshang; Moradi, Mehdi; Farzan, Mahmoud

doi:10.1016/j.clineuro.2016.10.007

Cited by 15 publications

(23 citation statements)

References 26 publications

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“…Four trials included only patients with a previous diagnosis of chronic pain condition. [94][95][96][97] The authors' responses contributed to the data on pain, 98 delirium, 99 and ataxia. 100 .…”

Section: Perioperative Medicinementioning

confidence: 99%

Perioperative Use of Gabapentinoids for the Management of Postoperative Acute Pain

Verret¹,

Lauzier²,

Zarychanski³

et al. 2020

Anesthesiology

301

193

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Background Widely used for acute pain management, the clinical benefit from perioperative use of gabapentinoids is uncertain. The aim of this systematic review was to assess the analgesic effect and adverse events with the perioperative use of gabapentinoids in adult patients. Methods Randomized controlled trials studying the use of gabapentinoids in adult patients undergoing surgery were included. The primary outcome was the intensity of postoperative acute pain. Secondary outcomes included the intensity of postoperative subacute pain, incidence of postoperative chronic pain, cumulative opioid use, persistent opioid use, lengths of stay, and adverse events. The clinical significance of the summary estimates was assessed based on established thresholds for minimally important differences. Results In total, 281 trials (N = 24,682 participants) were included in this meta-analysis. Compared with controls, gabapentinoids were associated with a lower postoperative pain intensity (100-point scale) at 6 h (mean difference, −10; 95% CI, −12 to −9), 12 h (mean difference, −9; 95% CI, −10 to −7), 24 h (mean difference, −7; 95% CI, −8 to −6), and 48 h (mean difference, −3; 95% CI, −5 to −1). This effect was not clinically significant ranging below the minimally important difference (10 points out of 100) for each time point. These results were consistent regardless of the type of drug (gabapentin or pregabalin). No effect was observed on pain intensity at 72 h, subacute and chronic pain. The use of gabapentinoids was associated with a lower risk of postoperative nausea and vomiting but with more dizziness and visual disturbance. Conclusions No clinically significant analgesic effect for the perioperative use of gabapentinoids was observed. There was also no effect on the prevention of postoperative chronic pain and a greater risk of adverse events. These results do not support the routine use of pregabalin or gabapentin for the management of postoperative pain in adult patients. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Section: Perioperative Medicinementioning

confidence: 99%

Perioperative Use of Gabapentinoids for the Management of Postoperative Acute Pain

Verret¹,

Lauzier²,

Zarychanski³

et al. 2020

Anesthesiology

301

193

View full text Add to dashboard Cite

show abstract

“…Nevertheless, in a study conducted by Zarei et al in 2016, postoperative pain in the lumbar region in patients receiving pregabalin was not significantly different that of the placebo group, which is not consistent with the results of the present study. This discrepancy might be due to differences in the study methods; accordingly, the study by Zarei et al continued for 2 weeks after the surgery, and patients were monitored for postoperative pain (11).…”

Section: Discussionmentioning

confidence: 99%

Effects of Two Different Preoperative Doses of Pregabalin on Postoperative Pain After Lumbar Disc Herniation Surgery

et al. 2021

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Background: Postoperative pain is a common and significant complication, and there are several ways to control it. In recent years, there has been a growing tendency to use pregabalin to control pain. Objectives: This study aimed to compare the effects of two different doses of pregabalin on postoperative pain after lumbar disc herniation surgery. Methods: This clinical trial study was performed on 90 patients undergoing elective herniated disc surgery in Khatam Al-Anbia Hospital of Zahedan, Iran, using random sampling. The patients were divided into three groups, including those receiving high dose pregabalin (150 mg), low dose pregabalin (75 mg), and placebo. The three groups were compared regarding postoperative pain, the received dose of analgesic, and the severity of side effects. The data were analyzed based on the Chi-square test and one-way analysis of variance using SPSS software (version 18). Results: In this study, the mean age of the patients was 43.9±6.7 years. The mean postoperative pain was significantly lower in both pregabalin groups than the placebo group (P < 0.05). Moreover, the mean postoperative pain in the high-dose pregabalin group was less than that of the low-dose group; however, the difference was not statistically significant (P > 0.05). Analgesics were needed for 8 patients (26.7%) of the low-dose pregabalin group. Furthermore, 7 patients (23.3%) of the high-dose pregabalin group and 16 patients (53.3%) of the placebo group also needed analgesics (P = 0.028). Additionally, 5 (16.7%), 8 (26.7%), and 4 (13.3%) patients in the low-dose pregabalin group, high-dose pregabalin group, and placebo group complained of side effects (P = 0.390). Conclusions: The present study showed that pregabalin significantly reduces postoperative pain and the required dose of analgesia. On the other hand, pregabalin complications are minor and can be neglected.

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“…Historically, the focus was on oral multimodal analgesic regimens which included medications such as acetaminophen, gabapentinoids, and anticonvulsants. 12 There has also been investigation into postoperative epidural analgesia’s efficacy in spine surgery with limited surgeon acceptance and complications, notably infection, hematoma, unpredictable spread, and postoperative motor block. 13 , 14 With increasing knowledge, paraspinal truncal blocks offer a new regional alternative to assess in postoperative analgesia after spine surgery.…”

Section: Discussionmentioning

confidence: 99%

<p>Postoperative “Rescue” Use of Erector Spinae Plane Block After Lumbar Spine Fusion: A Report of 2 Cases</p>

Kianpour¹,

Gundy²,

Nadler³

et al. 2020

LRA

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Pain after lumbar spine fusion surgery is often difficult to control in the immediate postoperative period. Historically, opioids have been the mainstay of treatment, but are associated with many unwanted side effects as well as increased hospital length of stay. The ultrasound-guided erector spinae plane block (ESP) is a relatively safe and simple regional option for the management of acute postoperative pain after spine surgery without the technical difficulty or complications noted with paravertebral injection (eg, pneumothorax, hematoma). To date, there have been reports of preoperative placement of ESP block prior to spine surgery with some success. We present a report of two cases that highlight the efficacy of the ESP block as an early postoperative "rescue" regional anesthetic technique in lumbar spine surgery. These cases demonstrate the potential effectiveness of a "rescue" use of the ESP block in patients having uncontrolled or poorly controlled pain in the early postoperative period with no evidence of significant side effects.

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Management of postoperative pain after Lumbar surgery—pregabalin for one day and 14 days—a randomized, triple-blinded, placebo-controlled study

Cited by 15 publications

References 26 publications

Perioperative Use of Gabapentinoids for the Management of Postoperative Acute Pain

Perioperative Use of Gabapentinoids for the Management of Postoperative Acute Pain

Effects of Two Different Preoperative Doses of Pregabalin on Postoperative Pain After Lumbar Disc Herniation Surgery

<p>Postoperative “Rescue” Use of Erector Spinae Plane Block After Lumbar Spine Fusion: A Report of 2 Cases</p>

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