Preventive Gabapentin versus Pregabalin to Decrease Postoperative Pain after Lumbar Microdiscectomy: A Randomized Controlled Trial

Abstract

Study DesignRandomized controlled trial.PurposeThe purpose of this study was to compare pregabalin and gabapentin for mean postoperative visual analog score (VAS) for pain in patients undergoing single-level lumbar microdiscectomy for intervertebral disc prolapse at a tertiary care hospital.Overview of LiteraturePregabalin has a superior pharmacokinetic profile and analgesic effect at lower doses than gabapentin; however, analgesic efficacy must be established during the perioperative period after lumbar spine surgery.MethodsThis randomized controlled trial was carried out at our institute from February to October 2011 on 78 patients, with 39 participants in each study group. Patients undergoing lumbar microdiscectomy were randomized to group A (gabapentin) or group B (pregabalin) and started on trial medicines one week before surgery. The VAS for pain was recorded at 24 hours and one week postoperatively.ResultsBoth groups had similar baseline variables, with mean ages of 42 and 39 years in groups A and B, respectively, and a majority of male patients in each group. The mean VAS values for pain at 24 hours for gabapentin vs. pregabalin were comparable (1.97±0.84 vs. 1.6±0.87, respectively; p=0.087) as were the results at one week after surgery (0.27±0.45 vs. 0.3±0.46, respectively; p=0.79). None of the patients required additional analgesia postoperatively. After adjusting for age and sex, the VAS value for group B patients was 0.028 points lower than for group A patients, but this difference was not statistically significant (p=0.817, R2=0.018).ConclusionsPregabalin is equivalent to gabapentin for the relief of postoperative pain at a lower dose in patients undergoing lumbar microdiscectomy. Therefore, other factors, such as dose, frequency, cost, pharmacokinetics, and side effects of these medicines, should be taken into account whenever it is prescribed.

Prevention and Treatment of Postoperative Pain after Lumbar Spine Procedures: A Systematic Review

“…The epidural approach provides better early pain control, with fewer PONV events and a lower request for supplemental analgesics, suggesting that as long as patients are selected carefully, spinal anesthesia may be a safer and a more economical alternative; however, locoregional anesthesia can be precluded in some cases of coagulopathy . In recent years, researchers have focused on the use of systemic drugs combinations: our results show that gabapentinoids may have their greatest impact as part of a multimodal analgesic approach, and question the analgesic efficacy of pregabalin/gabapentin as a single drug in the treatment of postoperative pain following lumbar spine procedures, especially in a preemptive approach . As confirmed by recent meta‐analysis studies about the efficacy of pregabalin in reducing postoperative pain, several studies were found to have limitations (number of studies and sample size); therefore, a multicenter RCT is needed to accurately identify the effects and optimal dose of pregabalin for reducing acute pain after spine surgery .…”

“…Of the 14 RCTs that evaluated systemic pharmacological therapies to prevent and treat postoperative pain after lumbar spine procedures, pregabalin was tested in 7 RCTs, nonsteroidal anti‐inflammatory drugs (NSAIDs) in 2 RCTs, and other drugs (dexamethasone, minocycline, propofol, sevoflurane, paracetamol, naproxen, ketamine, and clonidine) in the remaining 5 RCTs . Of the 7 RCTs that tested pregabalin, 4 demonstrated that pregabalin alone or in association with other drugs was more effective than placebo, 1 that it was as effective as placebo, and 2 that it was more effective than morphine in preventing postoperative pain . The 2 RCTs that tested NSAIDs showed that parecoxib, ketorolac, and etoricoxib were more effective than placebo in preventing postoperative pain .…”

“…84 In recent years, researchers have focused on the use of systemic drugs combinations: our results show that gabapentinoids may have their greatest impact as part of a multimodal analgesic approach, and question the analgesic efficacy of pregabalin/gabapentin as a single drug in the treatment of postoperative pain following lumbar spine procedures, especially in a preemptive approach. [25][26][27][28][29][30][31] As confirmed by recent meta-analysis studies about the efficacy of pregabalin in reducing postoperative pain, several studies were found to have limitations (number of studies and sample size); therefore, a multicenter RCT is needed to accurately identify the effects and optimal dose of pregabalin for reducing acute pain after spine surgery. 85 In contrast to the previous review, preoperative bupivacaine alone proved to be as effective as levobupivacaine in reducing both opioid consumption and pain scores, and was shown to be more effective when combined with intrathecal MgSO 4 .…”

“…The 23 RCTs that tested therapies administered in the preoperative period included systemic pharmacological therapies (14 studies), [25][26][27][28][29][30][31][32][33][34][35][36][37][38] locoregional therapies (7 studies), [39][40][41][42][43][44][45] and electrical stimulation (2 studies) 46,47 (see Table 2).…”

“…[34][35][36][37][38] Of the 7 RCTs that tested pregabalin, 4 demonstrated that pregabalin alone or in association with other drugs was more effective than placebo, 1 that it was as effective as placebo, and 2 that it was more effective than morphine in preventing postoperative pain. [25][26][27][28][29][30][31] The 2 RCTs that tested NSAIDs showed that parecoxib, ketorolac, and etoricoxib were more effective than placebo in preventing postoperative pain. 32,33 Dexamethasone, paracetamol, and the combination of ketamine-clonidine led to positive results on postoperative pain prevention.…”