Preoperative Sedation, Hemodynamic Stability during General Anesthesia and Improving Postoperative Pain: Pregabalin Is the Answer

Abstract

Background: Tracheal intubation is a noxious stimulus that tends to provoke a marked sympathetic response which is potentially deleterious in some patients. Various methods have been used to minimize and attenuate these potentially harmful responses. Aim of the study: The present study compared the efficacy and safety of two different doses (150 mg and 300 mg) of oral pregabalin premedication on attenuation of the hemodynamic pressor response to airway instrumentation, perioperative hemodynamic stability, preoperative sedation, and postoperative pain reduction. Patients and methods: This prospective, observational study consisted of 60 adult patients scheduled for laparoscopic cholecystectomy. The patients were randomized into three groups of 20 patients each. Group I (P0) received an oral placebo, group II (P150) received 150 mg of oral pregabalin and group III (P300) received 300 mg of oral pregabalin 1 h prior to induction. All patients were assessed for pre-operative sedation, perioperative hemodynamic changes, Post-operative pain and analgesic consumption. Results: Regarding the efficacy of the preoperative administration of oral pregabalin, a dose dependent attenuation in the increased in heart rate, systolic, and diastolic blood pressure, and mean arterial blood pressure resulting from laryngoscopy and intubation was observed (300 mg > 150 mg), along with a subsequent decrease in intraoperative fentanyl supplementation. On anxiolysis, patients were more comfortable and asleep in the pregabalin groups as compared with the control group, in which more patients were awake and agitated. Post-operative pain and analgesic consumption were effectively reduced by (150 mg and 300 mg) pregabalin in a dose-dependent manner. Postoperative nausea and vomiting were significantly lower with the administration of pregabalin compared with the placebo group (P < 0.008). Additionally, pregabalin increased the incidence of dizziness and visual disturbances in a dose-dependent manner. Con- clusion: Oral pregabalin premedication adequately sedated patients and attenuated the hemodynamic pressor response to airway instrumentation in a dose-dependent manner. Premedicated patients were haemodynamically stable perioperatively without recovery time prolongation or side effects, except dizziness with 300 mg of oral pregabalin. Additionally, oral pregabalin reduced postoperative pain and analgesic consumption in a dose-dependent manner.

Use of Low Dose Pregabalin for Attenuation of Hemodynamic Response to Laryngoscopy and Intubation in Treated Hypertensive Patients

“…An initial increase in heart rate was present in both the groups, however it reduced faster in the pregabalin group compared to placebo when measured at 3 and 5 minutes. The results were consistent with the study by Meena et al 17 and El-Hussiny H et al 18 where the rise of heart rate was of shorter duration in the pregabalin group. In the study done by Rastogi et al 7 , there was a significant rise in heart rate postintubation in the pregabalin group.…”

“…The haemodynamic results of our study were in agreement with the other studies. 8,18,19 A similar observation was also found by Eren et al 20 on cardiovascular response to tracheal intubation with and without pregabalin premedication. Gupta K et al 21 , however, showed an initial rise in the mean arterial after premedication but it was significantly attenuated after induction and laryngoscopy in the pregabalin group.…”

Comparative Study of the Neurotoxic Effects of Pregabalin Versus Tramadol in Rats

“…One could attribute this decline to the sedative effect of pregabalin. Our results could be explained by the reported dose-dependent sedative impact of pregabalin administration in clinical investigations (El-Hussiny et al 2018). The inhibitory impact of pregabalin on the release of excitatory neurotransmitters in the brain has been linked to its sedative effect (Calandre et al 2016).…”