Effective Dose of Peri-operative Oral Pregabalin as an Adjunct to Multimodal Analgesic Regimen in Lumbar Spinal Fusion Surgery

In Brief Study Design. A prospective, randomized, controlled, and double-blind trial. Objective. To evaluate the effects of 2 different doses of perioperative pregabalin administration, twice on the day of surgery, on acute postoperative pain after spinal surgery. Summary of Background Data. Besides its well-established role on neuropathic pain, pregabalin seems to be a promising adjunct to multimodal analgesic regimen following surgery. No comprehensive data exist regarding the optimal dosage of pregabalin on reducing postoperative pain and opioid consumption in spinal surgery. Methods. Patients were randomly assigned to 1 of 3 groups. The placebo group (n = 28) received placebo capsules 1 hour before the anesthetic induction and 12 hours after surgery. The pregabalin groups received pregabalin 75 mg (P75 group, n = 28) or 150 mg (P150 group, n = 28), respectively at the same points. Assessed variables were total amount of administered fentanyl-based intravenous patient-controlled analgesia, pain intensity, and the frequency of rescue analgesic administered during the first 48 hours after surgery, subdivided into the following 4 periods: on arrival of patient to the postanesthesia care unit, 1 to 6 hours, 6 to 24 hours, and 24 to 48 hours. Results. The amount of patient-controlled analgesia volume infused until 24 hours (P = 0.025) and 48 hours (P = 0.028) after surgery was significantly less in the P150 group compared with the control group. The frequency of additional anodynes administered until 6 hours (P = 0.049) and 24 hours (P = 0.045) after surgery was significantly less in the P150 group compared with the control group. Conclusion. Perioperative administration of pregabalin 150 mg before and 12 hours after surgery, but not 75 mg, significantly reduced opioid consumption and the use of additional pain rescue for 48 hours after surgery without significant side effects in patients undergoing spinal fusion surgery. Adequate management of postoperative pain following spinal surgery is essential to improve patients' satisfaction as well as to facilitate early mobilization and reduce hospital length of stay. Perioperative administration of pregabalin significantly reduced the infused volume of IV PCA and the incidence of additional pain rescues postoperatively without significant side effects.