Pregabalin reduces postoperative opioid consumption and pain for 1 week after hospital discharge, but does not affect function at 6 weeks or 3 months after total hip arthroplasty

Abstract

Background: This study examined whether a perioperative regimen of pregabalin added to celecoxib improved pain scores and functional outcomes postdischarge up to 3 months after total hip arthroplasty (primary outcome) and acute postoperative pain and adverse effects (secondary outcomes). Methods: One hundred and eighty-four patients were enrolled in a randomized, double-blind, placebo-controlled study. Two hours before receiving a spinal anaesthetic and undergoing surgery, patients received celecoxib 400 mg p.o. and were randomly assigned to receive either pregabalin 150 mg p.o. or placebo p.o. After surgery, patients received pregabalin 75 mg or placebo twice daily in hospital and for 7 days after discharge. Patients also received celecoxib 200 mg every 12 h for 72 h and morphine i.v. patient-controlled analgesia for 24 h. Pain and function were assessed at baseline, 6 weeks, and 3 months after surgery. Results: There was no difference between groups in physical function or incidence and intensity of chronic pain 3 months after total hip arthroplasty. The pregabalin group used less morphine [mean (): 39.85 (28.1) mg] than the placebo group [54.01 (31.2) mg] in the first 24 h after surgery (P<0.01). Pain scores were significantly lower in the pregabalin group vs the placebo group on days 1-7 after hospital discharge, and the pregabalin group required less adjunctive opioid medication (Percocet) 1 week after hospital discharge (P<0.05). Conclusions: Perioperative administration of pregabalin did not improve pain or physical function at 6 weeks or 3 months after total hip arthroplasty. Perioperative administration of pregabalin decreased opioid consumption in hospital and reduced daily pain scores and adjunct opioid consumption for 1 week after discharge.

Pregabalin does not affect fracture healing adversely

“…[11,12] In their study assessing the analgesic effect of pregabalin in orofacial rat models of acute inflammatory pain and of persistent pain associated with nerve injury and cancer, Hummig et al [12] concluded that it produced a marked antinociceptive effect. In a randomized, double-blind, placebocontrolled clinical trial, Clarke et al [4] mentioned that perioperative administration of pregabalin decreased opioid consumption in hospital and reduced daily pain scores and adjunct opioid consumption for one week after discharge following total hip arthroplasty. Sarıtaş et al [13] tested the effects of pregabalin on wound healing in a rat model and reported that inflammation scores were significantly lower and wound healing was significantly better in the control group when compared with treatment group until day 13.…”

“…As an adjunct drug for reducing postoperative pain, it may also be administered in surgically treated patients. [4,5] However, to the best of our knowledge, the effects of pregabalin on fracture healing have not been evaluated yet.…”

Acute pain trajectories and the persistence of post-surgical pain: a longitudinal study after total hip arthroplasty

“…Patients were recruited 2-3 weeks prior to surgery during the pre-assessment clinic or pre-operative rehabilitation education session. This study was part of a larger randomized controlled trial examining the efficacy of pregabalin versus placebo on rehabilitation, functional status, and pain outcomes [32].…”

“…Participants completed a series of questionnaires preoperatively (2-3 weeks prior to surgery) and postoperatively (daily during hospitalization and at 6 weeks and 6 months after surgery). Functional outcome measures and questionnaires included at other time points as part of the randomized controlled trial [32] are not presented here.…”

Transitional Pain Medicine: novel pharmacological treatments for the management of moderate to severe postsurgical pain

“…When we extrapolate this data to the 230 million people worldwide undergoing surgery annually, the cost from the development of CPSP totals in the hundreds of billions of dollars. [24] Novel pharmacologic interventions for the prevention of chronic postsurgical pain There are no clear guidelines for dealing with the management of postoperative pain as patients leave hospital and recover for 3-6 months, [25] or on postoperative opioid prescriptions as patients progress from the hospital setting to the community. [26,27] The TPS utilizes novel pharmacological approaches for patients suffering from moderate to severe acute postsurgical pain.…”