A prospective and comparative study to evaluate the efficacy of oral pregabalin vs gabapentin combined with IV paracetamol as preemptive analgesic for post-operative pain in patients undergoing single level open lumbar spine decompression surgery in a tertiary health care center

Rohit N. Garg; Shweta Sonu Vaje; Hrishikesh Patil; Sanket Bajaj

doi:10.18203/issn.2455-4510.IntJResOrthop20234046

Authors

Rohit N. Garg Department of Orthopaedics, Bharatratna Doctor Babasaheb Ambedkar Municipal Hospital, Kandivali, Maharashtra, India
Shweta Sonu Vaje Department of Anesthesia, Bharatratna Doctor Babasaheb Ambedkar Municipal Hospital, Kandivali, Maharashtra, India
Hrishikesh Patil Department of Orthopaedics, Bharatratna Doctor Babasaheb Ambedkar Municipal Hospital, Kandivali, Maharashtra, India
Sanket Bajaj Department of Orthopaedics, Bharatratna Doctor Babasaheb Ambedkar Municipal Hospital, Kandivali, Maharashtra, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20234046

Keywords:

Gabapentin, Pregabalin, Ramsay sedation score, Tramadol, Visual analog scale

Abstract

Background: Post-operative pain in spine surgery, whether neuropathic or nociceptive, presents a significant challenge for both surgeons and patients. Previous research has demonstrated the effectiveness of pre-operative oral gabapentinoids in reducing postoperative pain, extending the time to first rescue analgesia, and diminishing overall analgesic requirements.

Methods: This study involved 120 patients undergoing lumbar discectomy for disc herniation. They were randomly assigned to receive pre-operative oral pregabalin, gabapentin, or a placebo, along with IV paracetamol as preemptive analgesia. The study assessed their efficacy through post-operative pain scores (VAS), and sedation scores (Ramsay sedation score) at various intervals, time to first rescue analgesia, and total analgesia consumption.

Results: No significant differences were found in demographic variables, surgical levels, or duration among the groups. The placebo group had the shortest time to first rescue analgesia, while the pregabalin group showed the longest, with a notable difference. Across most time frames, the pregabalin group reported the lowest mean postoperative VAS scores, whereas the placebo group had the highest. Initial variations in sedation scores converged in later time frames, with the placebo group consistently recording the lowest scores. Total rescue analgesia (tramadol) in the initial 24 hours was highest in the placebo group, followed by the gabapentin group, and lowest in the pregabalin group, with no significant variance.

Conclusions: This study affirms the superiority of pre-operative oral pregabalin with IV paracetamol. It effectively prolongs the time to first rescue analgesia and reduces overall analgesic consumption post-lumbar spine surgery, compared to pre-operative oral gabapentin with IV paracetamol.

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References

Lellan K. Postoperative pain: strategy for improving patient experiences. J Adv Nurs. 2004;46(2):179-85.

Chung JW, Lui JC. Postoperative pain management: study of patients' level of pain and satisfaction with health care providers' responsiveness to their reports of pain. Nurs Health Sci. 2003;5(1):13-21.

Barrington JW, Halaszynski TM, Sinatra RS, Expert Working Group On Anesthesia And Orthopaedics Critical Issues In Hip And Knee Replacement Arthroplasty FT. Perioperative pain management in hip and knee replacement surgery. Am J Orthop. 2014;43(4):1-16.

Pearce CJ, Hamilton PD. Current concepts review: regional anesthesia for foot and ankle surgery. Foot Ankle Int. 2010;31(8):732-9.

Sinatra R. Causes and consequences inadequate management of acute pain. Pain 7. Med 2010;11(12):1859-71.

Lovich-Sapola J, Smith CE, Brandt CP. Wadhera R. Postoperative pain control. SurgClin North Am. 2015;95(2):301-18.

Vallejo R, Casasola O, Benyamin R. Opioid therapy and immunosuppression: a review. Am J Ther. 2004;11(5):354-65.

Dolin SJ, Cashman JN. Tolerability of acute postoperative pain management: nausea, vomiting, sedation, pruritus, and urinary retention. Evidence from published data. Br J Anaesth. 2005;95(5):584-91.

Rowbotham M, Harden N, Stacey B, Bernstein P, Magnus-Miller L. Gabapentin for the treatment of post herpetic neuralgia: a randomized controlled trial. JAMA. 1998;280(21):1837-42.

Devor M, Wall PD. Cross-excitation in dorsal root ganglia of nerve-injured and intact rats. J Neurophysiol. 1990;64(6):1733-46.

Bernard JM,Surbled M, Lagarde D, Trennec A. Analgesia after surgery of thespine in adults and adolescents. Cah Anesthesiol. 1995;43(6):557-64.

Gajraj NM. Pregabalin: its pharmacology and use in pain management. Anesth Analg. 2007;105(6):1805-15.

Menachem EB. Pregabalin pharmacology and its relevance to clinical practice. Epilepsy. 2004;45:13-8.

Hassan HI. Perioperative analgesic effects of intravenous paracetamol: Preemptive versus preventive analgesia in elective cesarean section. Anesth Essays Res. 2014;8(3):339-44.

Vincent D, Vishma K. Study of paracetamol infusion as pre-emptive analgesia in lower abdominal surgeries. IOSR J Dental Med Sci. 2017;16:92-6.

Werner MU, Perkins FM, Holte K, Pedersen JL, Kehlet H. Effects of gabapentin in acute inflammatory pain in humans. Reg Anesth Pain Med. 2001;26(4):322-8.

Yorimitsu E, Chiba K, Toyama Y, Hirabayashi K. Long-term outcomes of standard discectomy for lumbar disc herniation: a follow-up study of more than 10 years. Spine. 2001;26(6):652-7.

Caraceni A, Zecca E, Bonezzi C, Arcuri E, Tur RY, Maltoni M, et al. Gabapentin for neuropathic cancer pain: a randomized controlled trial from the Gabapentin Cancer Pain Study Group. J Clin Oncol. 2004;22(14):2909-17.

Jacquy J, Lossignol D, Sternon J. Pregabalin (Lyrica) and neuropathic pain syndromes. RevMed Brux. 2006;27(5):445-50.

Jokela R, Ahonen J, Tallgren M, Haanpaa M, Korttila K. Premedication with pregabalin 75 or 150mgwith ibuprofen to control pain after day-case gynaecological laparoscopic surgery. Br J Anaesth. 2008;100(6):834-40.

Mishra R, Tripathi M, Chandola HC. Comparative clinical study of gabapentin pregabalin for postoperative analgesia in laparoscopic cholecystectomy. Anesth Essays Res. 2016;10(2):201-6.

Bekawi MS, El Wakeel LM, Al Taher WM, Mageed WM. Clinical study evaluating pregabalin efficacy and tolerability for pain management in patients undergoing laparoscopic cholecystectomy. Clin J Pain. 2014;30(11):944-52.

Pandey CK, Navkar DV, Giri PJ, Raza M, Behari S, Singh RB, et al. Evaluation of the optimal preemptive dose of gabapentin for postoperative pain relief after lumbar Although in this study Pregabalin has been diskectomy: a randomized, double-blind, placebo-controlled study. J Neurosurg Anesthesiol. 2005;17(2):65-8.

Montazeri K, Kashefi P, Honarmand A. Preemptive gabapentin significantly reduces postoperative pain and morphine demand following lower extremity orthopaedic surgery. Sing Med J. 2007;48(8):748-51.

Ghai A, Gupta M, Hooda S, Singla D, Wadhera R. A randomized controlled trial to compare pregabalin with gabapentin for postoperative pain in abdominal hysterectomy. Saudi J Anaesth. 2011;5(3):252-7.

Mishra R, Tripathi M, Chandola H. Comparative clinical study of gabapentin Gabapentinand pregabalin for postoperative analgesia in laparoscopic cholecystectomy. Anesth Essays Res. 2016;10(2):201-9.

Eidy M, Fazel MR, Abdolrahimzadeh H, Moravveji AR, Kochaki E, Mohammadzadeh M. Effects of pregabalinand gabapentin on postoperative pain and opioid consumption after laparoscopic cholecystectomy. Korean J Anesthesiol. 2017;70(4):434-8.

Routray SS, Pani N, Mishra D, Nayak S. Comparison of pregabalin with gabapentin as preemptive analgesic in lumbar spine surgery. J Anaesthesiol Clin Pharmacol. 2018;34(2):232-6.

Kochhar A, Chouhan K, Panjiar P, Vajifdar H. Gabapentinoids as a part of multi-modal drug regime for pain relief following laparoscopic cholecystectomy: A randomized study. Anesth Essays Res. 2017;11(3):676-80.

SaraswatV, Arora V. Preemptive gabapentin vspregabalin for acute postoperative pain after surgery under spinal anaesthesia. Ind J Anaes. 2008;52(6):829-35.

Trivedi PA, Mehta M, Trivedi J. Preemptive gabapentin versus pregabalin for post-operative analgesia after abdominal hysterectomy under spinal anaesthesia. Int J Res Med. 2015;4(1):53-8.

Akhavanakbari G, Entezariasl M, Isazadehfar K, Mirzarahimi T. The effects of oral pregabalin on post-operative pain of lower limb orthopedic surgery: a double-blind, placebo-controlled trial. Pers Clin Res. 2013;4(3):165-70.

Turan A, Karamanlioglu B, Memis D, Hamamcioglu MK, Tükenmez B, Pamukçu Z, et al. Analgesic effects of gabapentin after spinal surgery. Anesthes 2004;100(4):935-8.

Yilmaz B, Yasar E, Koroglu OO, Goktepe AS, Tan AK. Gabapentin vs Pregabalin for the treatment of neuropathic pain in patients with spinal cord injury: a crossover study. Turk J Phys Med Rehab. 2014;61(1):1-5.

Maqsood S, Khan RA, Arshad A. A comparison of preemptive gabapentin with pregabalin for relief of postoperative pain in patients undergoing cholecystectomy. Pak Armed Forces Med J. 2017;67(5):843-6.

Agarwal A, Gautam S, Gupta D, Agarwal S, Singh PK, Singh U. Evaluation of single preoperative dose of pregabalin for attenuation of postoperative pain after laparoscopic cholecystectomy. Br J Anaesth. 2008;101(5):700-4.