pregabalin

Pregabalin

The probable mechanism of action is to reduce the release of several excitatory neurotransmitters by inhibiting calcium influx via the calcium channels 1) 2) 3) 4).

Pregabalin is pharmacologically superior to gabapentin due to its higher bioavailability (90% vs. 33%–66%), more rapid absorption (peak plasma level: 1 hr vs. 3–4 hrs) and linear increase in plasma concentration when its dose is increased. Lower doses of pregabalin than that of gabapentin (2–4 fold lower doses) have a similar analgesic effect on neuropathic pain, which makes pregabalin more advantageous in terms of the side effects from dosage 5) 6) 7).

Perioperative PG administration reduces early postsurgical pain at rest and particularly during movement after major spine surgery with less opioid consumption, and it seems to influence the improvement of overall QoL 3 months after surgery 8).

Preoperative pregabalin administration is associated with less pain intensity and improved functional outcomes 3 months after lumbar discectomy followed by gabapentin and then placebo.Level of Evidence: 2 9).

Both pregabalin 300 mg day-1 and gabapentin 1,200 mg day-1 have more analgesic, anxiolytic and opioid-sparing effects, higher patient satisfaction and are more effective for preventing postoperative shivering than the placebo following lumbar laminectomy and discectomy. Findings revealed that pregabalin 300 mg day-1 had equivalent analgesic, adverse and opioid-sparing effects and patient satisfaction as gabapentin 1,200 mg day-1 10).

Combined administration of pregabalin and dexamethasone conferred analgesic benefits superior to those of pregabalin alone. This regimen also helped facilitate return to normal daily activity after surgery 11).

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 12).

There is high-quality evidence that Nonsteroidal antiinflammatory drugs reduces pain up to 24 hours postoperatively. The evidence for reductions in pain with dexmedetomidine, pregabalin or gabapentin, scalp blocks, and scalp infiltration is less certain and of very low to moderate quality. There is low-quality evidence that scalp blocks and dexmedetomidine may reduce additional analgesics requirements. There is low-quality evidence that gabapentin or pregabalin may decrease nausea and vomiting, with the caveat that the total number of events for this comparison was low 13).

Of 105 patients who entered the run-in period, 47 patients (44.8%) were female and 58 (55.2%) were male. The Patients radicular pain mean score based on Numerical scale system (NRS) estimated before surgery was 7.22±1.95 in pregabalin14, 7.71±1.84 in pregabalin1 and 7.45±1.9 in control group. There were no statically significant differences between three groups (P-Value>0.05). The Patients back pain mean score based on NRS was 5.2±2.87 in pregabalin14, 5.11±3.23 in pregabalin1 and 6.4±3.06 in control group. This means that there were no significant differences in the overall score among those three groups (P-Value>0.05). In comparison to their preoperative pain, the average radicular pain in each group of patients improved significantly 4, 8, 12 and 24h after the operation (P-Value<0.001), but there were no significant differences in radicular pain improvements comparing three groups.

The results of this study indicate that 1day and 2 weeks post-operative 300mg pregabalin administration may not improve acute pain, morphine consumption and quality of life of patients after surgery. It seems that the diseases cause chronic pain that requires long-term treatment with higher doses 14).


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Gianesello L, Pavoni V, Barboni E, Galeotti I, Nella A. Perioperative pregabalin for postoperative pain control and quality of life after major spinal surgery. J Neurosurg Anesthesiol. 2012 Apr;24(2):121-6. doi: 10.1097/ANA.0b013e31823a885b. PubMed PMID: 22045156.
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Khurana G, Jindal P, Sharma J, Bansal K. Post Operative Pain and Long Term Functional Outcome Following Administration of Gabapentin & Pregabalin in Patients Undergoing Spinal Surgery. Spine (Phila Pa 1976). 2013 Dec 30. [Epub ahead of print] PubMed PMID: 24384657.
10)
Ozgencil E, Yalcin S, Tuna H, Yorukoglu D, Kecik Y. Perioperative administration of gabapentin 1,200 mg day-1 and pregabalin 300 mg day-1 for pain following lumbar laminectomy and discectomy: a randomised, double-blinded, placebo-controlled study. Singapore Med J. 2011 Dec;52(12):883-9. PubMed PMID: 22159931.
11)
Choi YS, Shim JK, Song JW, Kim JC, Yoo YC, Kwak YL. Combination of pregabalin and dexamethasone for postoperative pain and functional outcome in patients undergoing lumbar spinal surgery: a randomized placebo-controlled trial. Clin J Pain. 2013 Jan;29(1):9-14. doi: 10.1097/AJP.0b013e318246d1a9. PubMed PMID: 22751028.
12)
Kim JC, Choi YS, Kim KN, Shim JK, Lee JY, Kwak YL. Effective dose of peri-operative oral pregabalin as an adjunct to multimodal analgesic regimen in lumbar spinal fusion surgery. Spine (Phila Pa 1976). 2011 Mar 15;36(6):428-33. doi: 10.1097/BRS.0b013e3181d26708. PubMed PMID: 21372654.
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Galvin IM, Levy R, Day AG, Gilron I. Pharmacological interventions for the prevention of acute postoperative pain in adults following brain surgery. Cochrane Database Syst Rev. 2019 Nov 21;2019(11). doi: 10.1002/14651858.CD011931.pub2. Review. PubMed PMID: 31747720.
14)
Zarei M, Najafi A, Mansouri P, Sadeghi-Yazdankhah S, Saberi H, Moradi M, Farzan M. Management of postoperative pain after Lumbar surgery-pregabalin for one day and 14 days-a randomized, triple-blinded, placebo-controlled study. Clin Neurol Neurosurg. 2016 Oct 17;151:37-42. doi: 10.1016/j.clineuro.2016.10.007. PubMed PMID: 27764706.
  • pregabalin.txt
  • Last modified: 2019/11/21 21:23
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