Myhre M, Romundstad L, Stubhaug A
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
Department of Anesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Acta Anaesthesiol Scand. 2017 Nov;61(10):1314-1324. doi: 10.1111/aas.12963. Epub 2017 Aug 28.
Gabapentinoids are increasingly used to reduce acute postoperative pain, opioid consumption and opioid-related adverse effects. We explored the opioid-sparing, analgesic and anti-hyperalgesic effect of perioperative administered pregabalin in laparoscopic living donor nephrectomy.
In this randomized controlled trial, 80 patients were recruited and randomized to receive pregabalin 150 mg twice daily or placebo on the day of surgery and the first postoperative day as part of a multimodal analgesic regimen. Primary outcome was opioid consumption 0-48 h after surgery. Secondary outcomes were pain intensity at rest and with movement 0-48 h after surgery using the 0-10 Numeric Rating Scale and incisional hyperalgesia measured 24 h post-surgery and at hospital discharge. Further secondary outcomes were adverse effects. Persistent post-surgical pain was registered 6 weeks, 6 and 12 months after surgery.
Pregabalin significantly reduced opioid consumption compared with placebo 0-48 h after surgery (median mg [25th, 75th percentile]); 29.0 (22.0-45.5) vs. 41.8 (25.8-63.6) (P = 0.04). Pain intensity 0-48 h after surgery calculated as area under the pain (NRS) vs. time curve was not statistically different between groups at rest (P = 0.12) or with movement (P = 0.21). Pregabalin decreased incisional hyperalgesia 24 h after surgery (median cm [25th, 75th percentile] 8.5 (1.0-18.5) vs. 15.5 (9.5-24.0) (P = 0.02). Nausea (P ≤ 0.01), use of antiemetics (P ≤ 0.01) and pain-related sleep interference (P = 0.02) were reduced with pregabalin.
Perioperative pregabalin added to a multimodal analgesic regimen was opioid-sparing, but made no difference to pain intensity score 0-48 h after surgery. Pregabalin may reduce incisional hyperalgesia on the first day after surgery.
加巴喷丁类药物越来越多地用于减轻术后急性疼痛、减少阿片类药物用量及与阿片类药物相关的不良反应。我们探讨了围手术期给予普瑞巴林在腹腔镜活体供肾肾切除术中的阿片类药物节省、镇痛及抗痛觉过敏作用。
在这项随机对照试验中，招募了80例患者，并随机分为两组，在手术当天及术后第一天每天两次接受150mg普瑞巴林或安慰剂治疗，作为多模式镇痛方案的一部分。主要结局是术后0至48小时的阿片类药物用量。次要结局包括使用0至10数字评分量表评估术后0至48小时静息和活动时的疼痛强度，以及术后24小时和出院时测量的切口痛觉过敏。进一步的次要结局是不良反应。记录术后6周、6个月和12个月的持续性术后疼痛。
与安慰剂相比，普瑞巴林在术后0至48小时显著减少了阿片类药物用量（中位数mg[第25、75百分位数]）；29.0（22.0 - 45.5）对比41.8（25.8 - 63.6）（P = 0.04）。术后0至48小时静息（P = 0.12）或活动时（P = 0.21），以疼痛（数字评分量表）与时间曲线下面积计算的疼痛强度在两组间无统计学差异。普瑞巴林在术后24小时降低了切口痛觉过敏（中位数cm[第25、75百分位数] 8.5（1.0 - 18.5）对比15.5（9.5 - 24.0）（P = 0.02）。普瑞巴林降低了恶心（P≤0.01）、使用止吐药的情况（P≤0.01）以及与疼痛相关的睡眠干扰（P = 0.02）。
围手术期添加普瑞巴林的多模式镇痛方案具有阿片类药物节省作用，但对术后0至48小时的疼痛强度评分无影响。普瑞巴林可能会减轻术后第一天的切口痛觉过敏。
