The Effect of Perioperative Pregabalin on Pain after Arthroscopic Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial

Eun-Ah Cho,Namo Kim,Yong Seon Choi,Bora Lee,Jeehyun Song

doi:10.3390/jcm8091426

Abstract

Pain after anterior cruciate ligament (ACL) reconstruction is usually intense in the early postoperative period, but the efficacy of a multimodal analgesia approach remains controversial. This study aimed to investigate the analgesic efficacy of pregabalin in multimodal analgesia after ACL reconstruction. Patients who underwent ACL reconstruction under spinal anesthesia and agreed to use intravenous patient-controlled analgesia (IV-PCA) were randomly administered placebo (control group, n = 47) or pregabalin 150 mg (pregabalin group, n = 46) 1 h before surgery and 12 h after initial treatment. Pain by verbal numerical rating scale (VNRS) at rest and with passive flexion of knee was assessed at postoperative 12, 24, and 36 h and 2 weeks. IV-PCA consumption, rescue analgesic use, and side effects were also evaluated. Lower scores of VNRS were obtained with passive flexion of knee in the pregabalin group than in the control group at postoperative 24 (7(4–8) vs. 8(6–9), p = 0.043) and 36 h (4(3–7) vs. 5(4–9), p = 0.042), and lower value of VNRS at rest was observed in the pregabalin group [0(0–1)] than in the control group [1(0–2)] at postoperative 2 weeks (p < 0.001). No differences were obtained for IV-PCA consumption, rescue analgesic use, and side effects except for dizziness for postoperative 12 h. Pregabalin as an adjuvant to multimodal analgesic regimen significantly reduced early postoperative pain in patients undergoing ACL reconstruction.

Highlights

Arthroscopic anterior cruciate ligament (ACL) reconstruction is a common surgery of the knee
Regarding postoperative pain after ACL reconstruction, our results demonstrated that administration of pregabalin at 1 h before the start of surgery and 12 h after administration of the initial dose, significantly reduced postoperative pain without additional use of postoperative opioid and intravenous patient-controlled analgesia (IV-PCA)
Our results clearly demonstrated that perioperative pregabalin reduced acute postoperative pain, we were unable to clarify whether a reduction of pain at the early postoperative period could lead to improvement of long-term functional recovery after ACL reconstruction

Summary

Introduction

Arthroscopic anterior cruciate ligament (ACL) reconstruction is a common surgery of the knee. For passage of the ACL graft during ACL reconstruction, surgeons construct femoral and tibial tunnels, which results in moderate to severe pain in the early postoperative period [1]. Controlled pain could delay early rehabilitation and functional recovery and lead to adverse outcomes. Pain control in the early period after ACL reconstruction is important for effective rehabilitation and faster recovery [2]. Multimodal analgesia is based on the concept that various pathways are involved in pain. Recent studies have shown that perioperative administration of pregabalin in multimodal analgesia prevents hyperalgesia and reduces postoperative pain and opioid consumption in patients undergoing various types of surgeries [4,5,6,7]. Pregabalin, a γ-aminobutyric acid analogue, inhibits voltage-gated calcium influx at the nerve terminals, which in turn reduces the release of excitatory neurotransmitters [4,8]; it gradually attenuates central sensitization of the dorsal horn neurons and prevents hyperalgesia [5]

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