Perioperative Use of Pregabalin
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Published:
Feb 3, 2021
Keywords:
: perioperative, postoperative pain, pregabalin, preoperative anxiety
Main Article Content
Abstract
Nowadays, there are a large number of studies on perioperative use of pregabalin. This article describes the effects of pregabalin on acute postoperative pain, chronic postsurgical pain (CPSP) and preoperative anxiety, and how to optimize perioperative use of pregabalin. Pregabalin reduces immediate postoperative pain, opioid consumption and opioid-related side effects. The optimal dose and duration of pregabalin is unknown but the existing data suggest that higher dose is significantly more effective than lower dose. However, higher dose of pregabalin is associated with more side effect (dose-dependent). There are insufficient data to conclude the effect of pregabalin on reduction of preoperative anxiety and prevention of chronic postsurgical pain.
Article Details
Section
Review articles
References
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management. Anesth Analg 2007;105:1805-15.
2. Taylor CP, Angelotti T, Fauman E. Pharmacology and
mechanism of action of pregabalin: the calcium channel
alpha2-delta subunit as a target for antiepileptic drug
discovery. Epilepsy Res2007;73:137-50.
3. Ben-Menachem E. Pregabalin pharmacology and its
relevancetoclinical practice. Epilepsia2004;45:13-8.
4. Bockbrader HN, Radulovic LL, Posvar EL, et al. Clinical
pharmacokineticsof pregabalininhealthyvolunteers.J Clin
Pharmacol2010;50:941-50.
5. Schulze-BonhageA. Pharmacokineticand pharmacodynamic
profileof pregabalinand itsroleinthetreatmentofepilepsy.
Expert Opin Drug Metab Toxicol2013;9:105-15.
6. Peter C. Schmidt MD. Perioperative gabapentinoids.
Anesthesiology2013;119:1215-21.
7. Pfizer (Thailand) Company Limited. Prescribing information
for lyrica[pamphlet]. Bangkok: Company;2016.
8. YoshimuraN, IidaH,TakenakaM,etal. Effectof postoperative
administration of pregabalin for post-thoracotomy pain: a
randomized study. J Cardiothorac Vasc Anesth 2015;29:
1567-72.
9. Pesonen A, Suojaranta-Ylinen R, Hammaren E, et al.
Pregabalin has an opioid-sparing effect in elderly patients
aftercardiacsurgery:arandomized placebo-controlled trial.
Br J Anaesth2011;106:873-81.
10. Eidy M, Fazel MR, Abdolrahimzadeh H, Moravveji AR,
Kochaki E, Mohammadzadeh M. Effects of pregabalin and
gabapentin on postoperative pain and opioid consumption
after laparoscopic cholecystectomy. Korean J Anesthesiol
2017;70:434-8.
11. Asgari Z, Rouholamin S, Nataj M, Sepidarkish M, Hosseini
R, Razavi M. Dose ranging effects of pregabalin on pain
in patients undergoing laparoscopic hysterectomy:
A randomized, double blinded, placebo controlled, clinical
trial. J Clin Anesth2017;38:13-7.
12. Balaban F, Yagar S, Ozgok A, Koc M, Gullapoglu H.
A randomized, placebo-controlled study of pregabalin
for postoperative pain intensity after laparoscopic
cholecystectomy. J Clin Anesth2012;24:175-8.
13. Bekawi MS, El Wakeel LM, Al Taher WM, Mageed WM.
Clinicalstudyevaluating pregabalinefficacyand tolerability
for pain management in patients undergoing laparoscopic
cholecystectomy. ClinJ Pain2014;30:944-52.
14. Fassoulaki A, Melemeni A, Tsaroucha A, Paraskeva A.
Perioperative pregabalin for acute and chronic pain after
abdominal hysterectomy or myomectomy: a randomised
controlled trial. Eur J Anaesthesiol2012;29:531-6.
15. Yucel A, Ozturk E, Aydogan MS, Durmus M, Colak C, Ersoy
MO. Effects of 2 different doses of pregabalin on morphine
consumption and pain after abdominal hysterectomy:
arandomized, double-blind clinical trial. CurrTher Res Clin
Exp 2011;72:173-83.
16. Fujita N, Tobe M, Tsukamoto N, Saito S, Obata H.
A randomized placebo-controlled study of preoperative
pregabalinfor postoperativeanalgesiain patients withspinal
surgery. J Clin Anesth2016;31:149-53.
17. Eskandar AM, Ebeid AM. Effect of pregabalin on
postoperative pain after shoulder arthroscopy. Egypt J
Anaesth2019;29:363-7.
18. Kumar KP, Kulkarni DK, Gurajala I, Gopinath R. Pregabalin
versus tramadol for postoperative pain management in
patients undergoing lumbar laminectomy: a randomized,
double-blinded, placebo-controlled study. J Pain Res
2013;6:471-8.
19. Sagit M, Yalcin S, Polat H, KorkmazF, Cetinkaya S, Somdas
MA. Efficacyofasingle preoperative doseof pregabalinfor
postoperative pain after septoplasty. J Craniofac Surg
2013;24:373-5.
20. Demirhan A, Tekelioglu UY, Akkaya A, et al. Effect of
pregabalin and dexamethasone addition to multimodal
analgesia on postoperative analgesia following rhinoplasty
surgery. Aesthetic Plast Surg 2013;37:1100-6.
21. Mathiesen O, Jorgensen DG, Hilsted KL, et al. Pregabalin
and dexamethasoneimproves post-operative paintreatment
after tonsillectomy. Acta Anaesthesiol Scand 2011;55:
297-305.
22. Mishriky BM, Waldron NH, Habib AS. Impact of pregabalin
on acute and persistent postoperative pain: a systematic
review and meta-analysis. Br J Anaesth2015;114:10-31.
23. Buvanendran A, Kroin JS, Kari M, Tuman KJ. Can a single
doseof300 mg of pregabalinreachacuteantihyperalgesic
levels inthecentralnervous system? Reg Anesth Pain Med
2010;35:535-8.
24. Searle RD, Simpson KH. Chronic post-surgical pain. Contin
Educ Anaesth Crit Care Pain2010;10:12-4.
25. Werner MU, Kongsgaard UE. I. Defining persistent
post-surgical pain: is an update required? Br J Anaesth
2014;113:1-4.
26. Martinez V, Pichard X,Fletcher D. Perioperative pregabalin
administration doesnot preventchronic postoperative pain:
systematicreview witha meta-analysisof randomized trials.
Pain2017;158:775-83.
27. Clarke H, Bonin RP, Orser BA, Englesakis M, Wijeysundera
DN, KatzJ.The preventionofchronic postsurgical painusing
gabapentinand pregabalin:acombined systematicreview
and meta-analysis. Anesth Analg 2012;115:428-42.
28. Chaparro LE, Smith SA, Moore RA, Wiffen PJ, Gilron I.
Pharmacotherapy for the prevention of chronic pain after
surgery in adults. Cochrane Database Syst Rev 2013:
CD008307.
29. Ramsay MAE. A survey of pre-operative fear. Anesthesia
1972;27:396-402.
30. Daria U, Kumar V. Prevalence and factort responsible for
preoperativeanxietyinelective patients. IntJ Sci Res2018;
7:35-8.
31. NigussieS,BelachewT,WolanchoW.Predictorsofpreoperative
anxietyamongsurgicalpatientsinJimmaUniversitySpecialized
Teaching Hospital, South Western Ethiopia. BMC Surg
2014;14:67-76.
32. WoldegerimaYB,FitwiGL,YimerHT,HailekirosAG.Prevalence
and factors associated with preoperative anxiety among
elective surgical patients at University of Gondar Hospital,
Gondar, Northwest Ethiopia,2017, A cross-sectional study.
Int J Surg 2018;10:21-9.
33. Kil HK, Kim WO, Chung WY, Kim GH, Seo H, Hong JY.
Preoperative anxiety and pain sensitivity are independent
predictors of propofol and sevoflurane requirements in
generalanaesthesia. Br J Anaesth2012;108:119-25.
34. OsbornTM, Sandler NA.Theeffectsof preoperativeanxiety
onintravenous sedation. Anesth Prog 2004;52:46-51.
35. Stamenkovic DM, Rancic NK,Latas MB,etal. Preoperative
anxietyand implicationson postoperativerecovery, what we
can do to change our history. Minerva Anestesiol 2018;84:
1307-17.
36. Ali A, Altun D, Oguz BH, Ilhan M, DemircanF, Koltka K.The
effect of preoperative anxiety on postoperative analgesia
and anesthesiarecoveryin patientsundergoing laparascopic
cholecystectomy. J Anesth2014;28:222-7.
37. Sobol-KwapinskaM,BabelP,PlotekW,StelcerB.Psychological
correlates of acute postsurgical pain: A systematic review
and meta-analysis. Eur J Pain2016;20:1573-86.
38. Williams JB, Alexander KP, Morin JF, et al. Preoperative
anxiety as a predictor of mortality and major morbidity in
patientsaged >70yearsundergoing cardiacsurgery. Am J
Cardiol2013;111:137-42.
39. Cserép Z,Losoncz E,Balog P,etal.Theimpactof preoperative
anxiety and education level on long-term mortality after
cardiacsurgery. J Cardiothoracic Surg 2012;7:86-93.
40. Chou R, Gordon DB,Leon-Casasola OAd,etal.Management
of postoperative pain: a clinical practice guideline from the
American Pain Society, the American Society of Regional
Anesthesiaand Pain Medicine,and the American Societyof
Anesthesiologists’ Committee on Regional anesthesia,
Executive Committee, and Administrative Council. J Pain
2016;17:131-54.
management. Anesth Analg 2007;105:1805-15.
2. Taylor CP, Angelotti T, Fauman E. Pharmacology and
mechanism of action of pregabalin: the calcium channel
alpha2-delta subunit as a target for antiepileptic drug
discovery. Epilepsy Res2007;73:137-50.
3. Ben-Menachem E. Pregabalin pharmacology and its
relevancetoclinical practice. Epilepsia2004;45:13-8.
4. Bockbrader HN, Radulovic LL, Posvar EL, et al. Clinical
pharmacokineticsof pregabalininhealthyvolunteers.J Clin
Pharmacol2010;50:941-50.
5. Schulze-BonhageA. Pharmacokineticand pharmacodynamic
profileof pregabalinand itsroleinthetreatmentofepilepsy.
Expert Opin Drug Metab Toxicol2013;9:105-15.
6. Peter C. Schmidt MD. Perioperative gabapentinoids.
Anesthesiology2013;119:1215-21.
7. Pfizer (Thailand) Company Limited. Prescribing information
for lyrica[pamphlet]. Bangkok: Company;2016.
8. YoshimuraN, IidaH,TakenakaM,etal. Effectof postoperative
administration of pregabalin for post-thoracotomy pain: a
randomized study. J Cardiothorac Vasc Anesth 2015;29:
1567-72.
9. Pesonen A, Suojaranta-Ylinen R, Hammaren E, et al.
Pregabalin has an opioid-sparing effect in elderly patients
aftercardiacsurgery:arandomized placebo-controlled trial.
Br J Anaesth2011;106:873-81.
10. Eidy M, Fazel MR, Abdolrahimzadeh H, Moravveji AR,
Kochaki E, Mohammadzadeh M. Effects of pregabalin and
gabapentin on postoperative pain and opioid consumption
after laparoscopic cholecystectomy. Korean J Anesthesiol
2017;70:434-8.
11. Asgari Z, Rouholamin S, Nataj M, Sepidarkish M, Hosseini
R, Razavi M. Dose ranging effects of pregabalin on pain
in patients undergoing laparoscopic hysterectomy:
A randomized, double blinded, placebo controlled, clinical
trial. J Clin Anesth2017;38:13-7.
12. Balaban F, Yagar S, Ozgok A, Koc M, Gullapoglu H.
A randomized, placebo-controlled study of pregabalin
for postoperative pain intensity after laparoscopic
cholecystectomy. J Clin Anesth2012;24:175-8.
13. Bekawi MS, El Wakeel LM, Al Taher WM, Mageed WM.
Clinicalstudyevaluating pregabalinefficacyand tolerability
for pain management in patients undergoing laparoscopic
cholecystectomy. ClinJ Pain2014;30:944-52.
14. Fassoulaki A, Melemeni A, Tsaroucha A, Paraskeva A.
Perioperative pregabalin for acute and chronic pain after
abdominal hysterectomy or myomectomy: a randomised
controlled trial. Eur J Anaesthesiol2012;29:531-6.
15. Yucel A, Ozturk E, Aydogan MS, Durmus M, Colak C, Ersoy
MO. Effects of 2 different doses of pregabalin on morphine
consumption and pain after abdominal hysterectomy:
arandomized, double-blind clinical trial. CurrTher Res Clin
Exp 2011;72:173-83.
16. Fujita N, Tobe M, Tsukamoto N, Saito S, Obata H.
A randomized placebo-controlled study of preoperative
pregabalinfor postoperativeanalgesiain patients withspinal
surgery. J Clin Anesth2016;31:149-53.
17. Eskandar AM, Ebeid AM. Effect of pregabalin on
postoperative pain after shoulder arthroscopy. Egypt J
Anaesth2019;29:363-7.
18. Kumar KP, Kulkarni DK, Gurajala I, Gopinath R. Pregabalin
versus tramadol for postoperative pain management in
patients undergoing lumbar laminectomy: a randomized,
double-blinded, placebo-controlled study. J Pain Res
2013;6:471-8.
19. Sagit M, Yalcin S, Polat H, KorkmazF, Cetinkaya S, Somdas
MA. Efficacyofasingle preoperative doseof pregabalinfor
postoperative pain after septoplasty. J Craniofac Surg
2013;24:373-5.
20. Demirhan A, Tekelioglu UY, Akkaya A, et al. Effect of
pregabalin and dexamethasone addition to multimodal
analgesia on postoperative analgesia following rhinoplasty
surgery. Aesthetic Plast Surg 2013;37:1100-6.
21. Mathiesen O, Jorgensen DG, Hilsted KL, et al. Pregabalin
and dexamethasoneimproves post-operative paintreatment
after tonsillectomy. Acta Anaesthesiol Scand 2011;55:
297-305.
22. Mishriky BM, Waldron NH, Habib AS. Impact of pregabalin
on acute and persistent postoperative pain: a systematic
review and meta-analysis. Br J Anaesth2015;114:10-31.
23. Buvanendran A, Kroin JS, Kari M, Tuman KJ. Can a single
doseof300 mg of pregabalinreachacuteantihyperalgesic
levels inthecentralnervous system? Reg Anesth Pain Med
2010;35:535-8.
24. Searle RD, Simpson KH. Chronic post-surgical pain. Contin
Educ Anaesth Crit Care Pain2010;10:12-4.
25. Werner MU, Kongsgaard UE. I. Defining persistent
post-surgical pain: is an update required? Br J Anaesth
2014;113:1-4.
26. Martinez V, Pichard X,Fletcher D. Perioperative pregabalin
administration doesnot preventchronic postoperative pain:
systematicreview witha meta-analysisof randomized trials.
Pain2017;158:775-83.
27. Clarke H, Bonin RP, Orser BA, Englesakis M, Wijeysundera
DN, KatzJ.The preventionofchronic postsurgical painusing
gabapentinand pregabalin:acombined systematicreview
and meta-analysis. Anesth Analg 2012;115:428-42.
28. Chaparro LE, Smith SA, Moore RA, Wiffen PJ, Gilron I.
Pharmacotherapy for the prevention of chronic pain after
surgery in adults. Cochrane Database Syst Rev 2013:
CD008307.
29. Ramsay MAE. A survey of pre-operative fear. Anesthesia
1972;27:396-402.
30. Daria U, Kumar V. Prevalence and factort responsible for
preoperativeanxietyinelective patients. IntJ Sci Res2018;
7:35-8.
31. NigussieS,BelachewT,WolanchoW.Predictorsofpreoperative
anxietyamongsurgicalpatientsinJimmaUniversitySpecialized
Teaching Hospital, South Western Ethiopia. BMC Surg
2014;14:67-76.
32. WoldegerimaYB,FitwiGL,YimerHT,HailekirosAG.Prevalence
and factors associated with preoperative anxiety among
elective surgical patients at University of Gondar Hospital,
Gondar, Northwest Ethiopia,2017, A cross-sectional study.
Int J Surg 2018;10:21-9.
33. Kil HK, Kim WO, Chung WY, Kim GH, Seo H, Hong JY.
Preoperative anxiety and pain sensitivity are independent
predictors of propofol and sevoflurane requirements in
generalanaesthesia. Br J Anaesth2012;108:119-25.
34. OsbornTM, Sandler NA.Theeffectsof preoperativeanxiety
onintravenous sedation. Anesth Prog 2004;52:46-51.
35. Stamenkovic DM, Rancic NK,Latas MB,etal. Preoperative
anxietyand implicationson postoperativerecovery, what we
can do to change our history. Minerva Anestesiol 2018;84:
1307-17.
36. Ali A, Altun D, Oguz BH, Ilhan M, DemircanF, Koltka K.The
effect of preoperative anxiety on postoperative analgesia
and anesthesiarecoveryin patientsundergoing laparascopic
cholecystectomy. J Anesth2014;28:222-7.
37. Sobol-KwapinskaM,BabelP,PlotekW,StelcerB.Psychological
correlates of acute postsurgical pain: A systematic review
and meta-analysis. Eur J Pain2016;20:1573-86.
38. Williams JB, Alexander KP, Morin JF, et al. Preoperative
anxiety as a predictor of mortality and major morbidity in
patientsaged >70yearsundergoing cardiacsurgery. Am J
Cardiol2013;111:137-42.
39. Cserép Z,Losoncz E,Balog P,etal.Theimpactof preoperative
anxiety and education level on long-term mortality after
cardiacsurgery. J Cardiothoracic Surg 2012;7:86-93.
40. Chou R, Gordon DB,Leon-Casasola OAd,etal.Management
of postoperative pain: a clinical practice guideline from the
American Pain Society, the American Society of Regional
Anesthesiaand Pain Medicine,and the American Societyof
Anesthesiologists’ Committee on Regional anesthesia,
Executive Committee, and Administrative Council. J Pain
2016;17:131-54.