Jain Pradeep, Jolly Annu, Bholla Vaibahav, Adatia Sweta, Sood Jayashree
Department of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India.
Indian J Orthop. 2012 Nov;46(6):646-52. doi: 10.4103/0019-5413.104196.
Optimal pain treatment with minimal side effects is essential for early mobility and recovery in patients undergoing total knee arthroplasty (TKA). We investigated the effect of pregabalin as an adjuvant for postoperative analgesia provided by opioid-based patient-controlled epidural analgesia (PCEA) in such patients.
Forty patients undergoing unilateral primary TKA were randomly assigned to two equal groups, to receive either placebo or pregabalin 75 mg twice a day. The drug was administered orally starting before surgery and was continued for 2 days after surgery. Anesthetic technique was standardized. Postoperatively, static and dynamic pain was assessed by verbal rating score. Mean morphine consumption, PCEA usage, rescue analgesic requirement, and overall patient satisfaction were also assessed. Treatment emergent adverse drug reactions were recorded.
Mean morphine consumption was significantly reduced by pregabalin. Postoperative pain (both static and dynamic) and PCEA consumption too was significantly reduced in the pregabalin group during the first 48 h after surgery. This group needed fewer rescue analgesics and recorded higher overall patient satisfaction. Pregabalin-treated patients had fewer opioid-related adverse reactions like nausea, vomiting, and constipation. Dizziness was noted in two of the patients receiving pregabalin. There was no statically significant difference in the incidence of sedation in the two groups.
Oral pregabalin 75 mg started preoperatively is a useful adjunct to epidural analgesia following TKA. It reduces opioid consumption, improves postoperative analgesia, and yields higher patient satisfaction levels.
对于接受全膝关节置换术（TKA）的患者，以最小的副作用实现最佳疼痛治疗对于早期活动和恢复至关重要。我们研究了普瑞巴林作为基于阿片类药物的患者自控硬膜外镇痛（PCEA）辅助用药对这类患者术后镇痛的效果。
40例行单侧初次TKA的患者被随机分为两组，每组人数相等，分别接受安慰剂或每日两次、每次75mg的普瑞巴林治疗。药物在手术前开始口服，并在术后持续使用2天。麻醉技术标准化。术后，通过视觉模拟评分法评估静息和动态疼痛。还评估了吗啡的平均消耗量、PCEA的使用情况、急救镇痛药物的需求量以及患者总体满意度。记录治疗中出现的药物不良反应。
普瑞巴林显著降低了吗啡的平均消耗量。在术后的头48小时内，普瑞巴林组的术后疼痛（包括静息和动态疼痛）以及PCEA的使用量也显著降低。该组所需的急救镇痛药物较少，患者总体满意度较高。接受普瑞巴林治疗的患者出现恶心、呕吐和便秘等与阿片类药物相关的不良反应较少。接受普瑞巴林治疗的患者中有两人出现头晕。两组镇静发生率无统计学显著差异。
术前开始口服75mg普瑞巴林是TKA术后硬膜外镇痛的有效辅助用药。它可减少阿片类药物的消耗量，改善术后镇痛效果，并提高患者满意度。
