Comparative Evaluation of Pre Emptivesingle Dose Analgesia With Pregabalin vs Lumbar Epidural Analgesia Using Bupivacaine in Adult Patients Undergoing Laparoscopic Surgeries on Post Operative Pain and Haemodynamics

Background: Postoperative pain remains an important clinical concern after laparoscopic surgery despite the advantages ofminimally invasive techniques. Pre-emptive analgesic strategies such as oral pregabalin and lumbar epidural analgesia mayreduce postoperative pain and attenuate perioperative haemodynamic responses. The objective is to compare the effects of asingle preoperative oral dose of pregabalin 150 mg with lumbar epidural analgesia using 10 mL of 0.25% bupivacaine onpostoperative pain, haemodynamic parameters, duration of pain relief, rescue analgesic requirement, and adverse effects inadult patients undergoing laparoscopic surgery. Materials and Methods: This prospective, randomized, comparative studyincluded 90 adult patients aged 18–65 years with American Society of Anesthesiologists physical status I or II undergoingelective laparoscopic abdominal surgery under general anaesthesia. Patients were allocated into three equal groups of 30each. Group A received oral pregabalin 150 mg one hour before surgery, Group B received 10 mL of 0.25% bupivacainethrough lumbar epidural analgesia, and Group C received neither pregabalin nor epidural analgesia. Postoperative pain wasassessed using the Visual Analogue Scale (VAS). Heart rate, systolic blood pressure, diastolic blood pressure, mean arterialpressure, rescue analgesic requirement, duration of pain relief, Ramsay Sedation Score, postoperative nausea and vomiting,and other adverse effects were recorded. Results: The three groups were comparable with respect to age, sex, and body massindex. Following pneumoperitoneum, desufflation, and extubation, significant intergroup differences were observed in heartrate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure, with the control group showing greaterhaemodynamic responses. Postoperative VAS scores were significantly lower in the pregabalin group at 0, 1, 2, 4, and 6hours. At 6 hours, mean VAS scores were 1.26 ± 0.73 in Group A, 1.83 ± 0.91 in Group B, and 2.90 ± 1.02 in Group C(p<0.0001). The mean duration of pain relief was 6.48 ± 2.04 hours in the pregabalin group, 4.91 ± 1.44 hours in the epiduralgroup, and 2.68 ± 1.83 hours in the control group (p=0.001). During the first 2 postoperative hours, rescue analgesia was notrequired in Group A, compared with 3.33% in Group B and 33.33% in Group C. PONV occurred in 0%, 3.33%, and 20% ofpatients in Groups A, B, and C, respectively (p=0.008). No clinically significant differences in sedation were observedamong the groups. Conclusion: Single-dose pre-emptive oral pregabalin 150 mg provided effective postoperative analgesia,longer duration of pain relief, reduced rescue analgesic requirement, and favourable haemodynamic stability compared withlumbar epidural analgesia and control management in adult patients undergoing laparoscopic surgery.