Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland.
Department of Urology, University of Turku, Turku, Finland.
BMC Urol. 2021 Feb 2;21(1):14. doi: 10.1186/s12894-021-00785-9.
Previous findings indicate that pre-emptive pregabalin as part of multimodal anesthesia reduces opioid requirements compared to conventional anesthesia in patients undergoing robot-assisted laparoscopic prostatectomy (RALP). However, recent studies show contradictory evidence suggesting that pregabalin does not reduce postoperative pain or opioid consumption after surgeries. We conducted a register-based analysis on RALP patients treated over a 5-year period to evaluate postoperative opioid consumption between two multimodal anesthesia protocols.
We retrospectively evaluated patients undergoing RALP between years 2015 and 2019. Patients with American Society of Anesthesiologists status 1-3, age between 30 and 80 years and treated with standard multimodal anesthesia were included in the study. Pregabalin (PG) group received 150 mg of oral pregabalin as premedication before anesthesia induction, while the control (CTRL) group was treated conventionally. Postoperative opioid requirements were calculated as intravenous morphine equivalent doses for both groups. The impact of pregabalin on postoperative nausea and vomiting (PONV), and length of stay (LOS) was evaluated.
We included 245 patients in the PG group and 103 in the CTRL group. Median (IQR) opioid consumption over 24 postoperative hours was 15 (8-24) and 17 (8-25) mg in PG and CTRL groups (p = 0.44). We found no difference in postoperative opioid requirement between the two groups in post anesthesia care unit, or within 12 h postoperatively (p = 0.16; p = 0.09). The length of post anesthesia care unit stay was same in each group and there was no difference in PONV Similarly, median postoperative LOS was 31 h in both groups.
Patients undergoing RALP and receiving multimodal analgesia do not need significant amount of opioids postoperatively and can be discharged soon after the procedure. Pre-emptive administration of oral pregabalin does not reduce postoperative opioid consumption, PONV or LOS in these patients.
先前的研究结果表明，与常规麻醉相比，在接受机器人辅助腹腔镜前列腺切除术（RALP）的患者中，作为多模式麻醉一部分的预先使用普瑞巴林可减少阿片类药物的需求。然而，最近的研究结果却存在矛盾，表明普瑞巴林并不能减少手术后的疼痛或阿片类药物的消耗。我们对接受 RALP 治疗的患者进行了一项基于登记的分析，以评估两种多模式麻醉方案之间术后阿片类药物的消耗。
我们回顾性评估了 2015 年至 2019 年间接受 RALP 的患者。纳入的患者美国麻醉医师协会（ASA）分级为 1-3 级，年龄在 30 至 80 岁之间，接受标准多模式麻醉治疗。PG 组在麻醉诱导前接受 150mg 普瑞巴林口服作为术前用药，而对照组（CTRL）组则接受常规治疗。计算两组患者术后静脉内吗啡等效剂量作为术后阿片类药物的需求量。评估普瑞巴林对术后恶心呕吐（PONV）和住院时间（LOS）的影响。
我们纳入了 PG 组的 245 例患者和 CTRL 组的 103 例患者。PG 组和 CTRL 组 24 小时内术后吗啡消耗中位数（IQR）分别为 15（8-24）和 17（8-25）mg（p=0.44）。我们发现两组患者在麻醉后监护病房或术后 12 小时内的术后阿片类药物需求无差异（p=0.16；p=0.09）。两组患者的麻醉后监护病房停留时间相同，PONV 也无差异。同样，两组患者的术后 LOS 中位数均为 31 小时。
接受 RALP 并接受多模式镇痛的患者术后不需要大量的阿片类药物，并且在手术后不久即可出院。预先给予口服普瑞巴林并不能减少这些患者的术后阿片类药物消耗、PONV 或 LOS。
