Department of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore, Level 11 NUH Tower Block, 1E Kent Ridge Rd, Singapore, 119228, Singapore.
Department of Anaesthesia, National University Hospital, National University Health System, Singapore, Main Building Level 3, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.
Knee Surg Sports Traumatol Arthrosc. 2019 Jul;27(7):2104-2110. doi: 10.1007/s00167-019-05385-7. Epub 2019 Feb 9.
The purpose of this prospective, randomized, double-blinded, placebo-controlled study was to determine if pregabalin, when given perioperatively in addition to patient-controlled analgesia morphine, paracetamol and etoricoxib, is effective in reducing morphine requirements and moderating pain scores after primary total knee arthroplasty. We hypothesize that there would be no difference in postoperative opioid requirements, postoperative pain scores, and functional scores with the use of perioperative pregabalin.
Eighty-seven patients who underwent primary total knee arthroplasty were randomised and allocated to two groups. One group received capsules containing pregabalin 75 mg, and the other a placebo-one capsule before surgery and one capsule once per night up till postoperative day 2. Multimodal analgesia provided for all patients in this study included femoral nerve block, intravenous patient-controlled analgesia (morphine), paracetamol and etoricoxib. The primary outcome of patient's pain control was based on the measurement of cumulative morphine consumption during the first 72 h postoperatively.
Pregabalin did not reduce the cumulative or effective morphine consumption at 48 h and 72 h post-operation. There were also no significant differences noted in pain scores at 48 h and 72 h after surgery, functional range of motion of the operated knee at 72 h post-op, or outcomes recorded on the Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and 36-Item Short Form Survey (SF-36) questionnaires at 3 and 6 months post-op. None of the patients demonstrated common adverse reactions to pregabalin.
This study showed no reduction in postoperative opioid requirements, or improvement in early postoperative pain scores or functional outcomes at 6 months, with perioperative use of pregabalin. Orthopaedic surgeons may consider this when selecting an analgesic regimen for their patients.
II.
本前瞻性、随机、双盲、安慰剂对照研究旨在确定普瑞巴林是否可以在术后与患者自控镇痛吗啡、扑热息痛和依托考昔联合使用，从而有效减少初次全膝关节置换术后的吗啡需求并减轻疼痛评分。我们假设，在使用围手术期普瑞巴林时，术后阿片类药物的需求、术后疼痛评分和功能评分没有差异。
将 87 名接受初次全膝关节置换术的患者随机分组并分配到两组。一组患者接受含有 75mg 普瑞巴林的胶囊，另一组患者接受安慰剂-手术前服用一粒，术后每晚服用一粒，直至术后第 2 天。本研究中所有患者均接受多模式镇痛，包括股神经阻滞、静脉患者自控镇痛（吗啡）、扑热息痛和依托考昔。患者疼痛控制的主要结果基于术后 72 小时内累积吗啡消耗量的测量。
普瑞巴林并未减少术后 48 小时和 72 小时的累积或有效吗啡消耗量。术后 48 小时和 72 小时的疼痛评分、术后 72 小时膝关节活动度的功能范围、术后 3 个月和 6 个月膝关节学会评分（KSS）、安大略西部和麦克马斯特大学骨关节炎指数（WOMAC）和 36 项简明健康调查（SF-36）问卷的记录结果均无显著差异。没有患者出现普瑞巴林的常见不良反应。
本研究表明，围手术期使用普瑞巴林并未减少术后阿片类药物的需求，也未改善术后早期疼痛评分或 6 个月时的功能结果。骨科医生在为患者选择镇痛方案时可以考虑这一点。
II 级。
