Pre- versus Post-Incisional Pregabalin in Orthopaedic-Oncologic Patients: A Comparative, Randomized, Double-Blind, Controlled Study

Abstract

Background :Pain after the excision of orthopaedic-oncologic lesions is intense, and its suppression requires special measures. Multimodal analgesia, the currently preferred methodology, consists of two or more drugs administered concurrently, an approach which induces better postoperative analgesia than if administered singly. Pregabalin is an analgesia adjuvant that is administered perioperatively. Its pre- versus post-incisional pharmacological capabilities have never been compared in orthopaedic-oncologic patients. Objectives :To assess postoperative analgesic requirements and numerical pain scoresof pre- vs . post-surgically administered pregabalin in patients undergoing bone tumour resection, and the levels of pre-surgery anxiety and quality of the night’s sleep. Design : Prospective, double-blinded and randomised, comparative and controlled trial. Setting :A single tertiary care, university-affiliated, medical centre. Patients :One-hundred patients allocated into two study groups. Interventions : Fifty patients received 150 mg pregabalin twice before surgery and placebo after surgery (the PRE group), and 50 received placebo before surgery and pregabalin after it (the POST group) twice daily. Each protocol continued up to 72 h. Main Outcome Measures : The effects of both protocols on pain, on postoperative consumption of analgesics, and the effects of preoperative pregabalin on preoperative anxiety and on night’s sleep. Results : Both groups had similar ASA class, age and weight values. Both protocols resulted in similar patient-rated pain scales during postoperative days 0-3. The total consumption of opioids and non-opioid analgesics was also similar. Preoperatively pregabalin-treated patients were less anxious and slept better the night before surgery compared to placebos. There were no significant adverse events. Conclusions : Two preoperative or six postoperative pregabalin 150 mg doses provided similar control of postoperative pain and usage of opioids/non-steroidal anti-inflammatory drugs in patients undergoing surgery for orthopaedic-oncologic lesions. Each protocol was similarly safe and tolerable. Pre-surgical pregabalin reduced preoperative anxiety and improved preoperative night’s sleep.