Effect Of Pregabalin Research Articles

Interventions for the treatment of Radiotherapy Induced Trismus: A Systematic Review of the Literature

OBJECTIVES: To systematically assess the outcome of interventions used to treat patients who have trismus as a result of radiotherapy to the head and neck region in the treatment of Head and Neck Cancer (HNC). METHODOLOGY: Searches were carried out on online databases (Medline, Embase and The Cochrane Central Library) on the 19th of June 2019 and then again using the same search terms on the 6th of June 2021. Randomized and Nonrandomized trials aimed at treating trismus as a side effect of head and neck radiotherapy (RT) were included for this systematic review. A total of 5 papers were reviewed for the purpose of this systematic review. RESULTS: Results show that there is limited evidence to support the use of any treatment modality other than structured jaw exercises to help treat trismus in patients with a history of HNC and RT induced fibrosis. There is no evidence to support the use of Botulinum toxin A, while further studies are needed to clarify the effectiveness of Pentoxifylline (with or without conjunction with Vitamin E) and Pregabalin in the treatment of postradiotherapy fibrosis. CONCLUSION: There is a need for more randomized control trials to identify treatment modalities for radiotherapy induced trismus. Rehabilitation exercises have been implemented across all papers involved in this study which indicates the need for analysis and identification of a pharmaceutical intervention. KEYWORDS: Head and neck cancer, trismus, lockjaw, radiotherapy, randomized controlled trial, placebo

Sciatic Histological, Ultrastructural and Biochemical Investigations on Improving the Effect of Pregabalin by Flaxseed Oil on Diabetic Peripheral Neuropathy Induced in Albino Rats

Sciatic Histological, Ultrastructural and Biochemical Investigations on Improving the Effect of Pregabalin by Flaxseed Oil on Diabetic Peripheral Neuropathy Induced in Albino Rats

Long-Lasting Nociplastic Pain Modulation by Repeated Administration of Sigma-1 Receptor Antagonist BD1063 in Fibromyalgia-like Mouse Models.

Sigma-1 receptor (σ1R) ligands have been shown to be effective at relieving neuropathic and inflammatory pain, but have not yet been tested in experimental models of fibromyalgia. The objective of this study was to evaluate the effect of a σ1R antagonist (BD1063) compared to pregabalin. ICR-CD1 female mice were subjected to either six repeated injections of reserpine, to cause reserpine-induced myalgia (RIM6), or acidified saline intramuscular injections (ASI). In these two models, we evaluated the effect of BD1063 and pregabalin on thermal hypersensitivity, anxiety-like and depression-like behaviors, and on spinal cord gliosis. BD1063 exerted an antinociceptive effect on both reflexive (thermal hyperalgesia) and nonreflexive (anxiety- and depression-like) pain behaviors, and reduced spinal astroglial and microglial reactivity, following repeated treatment for 2 weeks. Interestingly, the effects of BD1063 were long-term, lasting several weeks after treatment discontinuation in both fibromyalgia-like models. Similar results were obtained with pregabalin, but the effects on pain behaviors lasted for a shorter length of time, and pregabalin did not significantly modulate spinal glial reactivity. The inhibitory and long-lasting effect of pharmacological blockade of σ1Rs on both sensory and affective dimensions of nociplastic-like pain and spinal cord gliosis in two experimental models of fibromyalgia support the application of this therapeutic strategy to treat fibromyalgia.

The Effect of Sumatriptan, Theophylline, Pregabalin and Caffeine on Prevention of Headache Caused By Spinal Anaesthesia (PDPH): A Systematic Review.

Spinal anaesthesia (SA) is a common method during surgery due to easy administration, rapid effects, relaxes muscles and controls pain. But, post-dural puncture headache (PDPH) is a common problem after SA that occurs in 6%-36% of SA. We assessed the effect of four common treatment drugs sumatriptan, theophylline, pregabalin and oral caffeine on prevention of PDPH. In this systematic review, all randomized clinical trials (RCTs) during January 2015 and December 2021 were searched from PubMed, Google Scholar, Web of Science, Cochrane review and Clinical Key with a specific search strategy. The article qualities were assessed by two independent authors and were screened for relevant sources based on inclusion and exclusion criteria. Moreover, the included articles data were extracted and checked for regular basis. A total of 421 articles were identified and 193 articles were removed following a preliminary review and finally, 14 articles were included in review. Overall, we identified five RCTs on the effect of caffeine, two RCTs on the effect of sumatriptan, three RCTs on theophylline, three RCTs on pregabalin and one RCT on theophylline and sumatriptan in PDPH prevention. This review supports the effects of theophylline, pregabalin and sumatriptan in the prevention of PDPH incidence and treatment of PDPH intensity, but we cannot draw the same conclusions about caffeine due to some negative results about the caffeine effect. Nevertheless, this extracted conclusion should be considered and interpreted with caution and limited generalizations due to the small number of studies, the variety of evaluated drugs and measures, the low sample size and the bias presented.

Effects of Gabapentin and Pregabalin on Calcium Homeostasis: Implications for Physical Rehabilitation of Musculoskeletal Tissues.

In this review, we discuss the mechanism of action of gabapentinoids and the potential consequences of long-term treatment with these drugs on the musculoskeletal system. Gabapentinoids, such as gabapentin (GBP) and pregabalin (PGB) were designed as antiepileptic reagents and are now commonly used as first-line treatment for neuropathic pain and increasingly prescribed off-label for other pain disorders such as migraines and back pain. GBP and PGB exert their analgesic actions by selectively binding the α2δ1 auxiliary subunit of voltage-sensitive calcium channels, thereby inhibiting channel function. Numerous tissues express the α2δ1 subunit where GBP and PGB can alter calcium-mediated signaling events. In tissues such as bone, muscle, and cartilage, α2δ1 has important roles in skeletal formation, mechanosensation, and normal tissue function/repair that may be affected by chronic use of gabapentinoids. Long-term use of gabapentinoids is associated with detrimental musculoskeletal outcomes, including increased fracture risk. Therefore, understanding potential complications is essential for clinicians to guide appropriate treatments.

The effectiveness of pregabalin with or without agomelatine in the treatment of chronic low back pain: a double-blind, placebo-controlled, randomized clinical trial

BackgroundAlthough various pharmacological and nonpharmacological treatments are available for the chronic low back pain (CLBP), there is no consensus on the best optimal treatment for this condition. This study aimed to investigate the efficacy of co-administration of pregabalin and agomelatine versus pregabalin with placebo to treat CLBP.MethodsForty-six CLBP patients without the surgical indication referred to the outpatient orthopedic clinic of Rasoul-e-Akram Hospital, Tehran, Iran, were randomly divided into two study groups: Group A [pregabalin (75 mg twice per day) + placebo] and Group B [pregabalin (75 mg twice per day) + agomelatine (25 mg per night)]. Patients were evaluated at weeks 0, 4, and 8. Outcome measures were the Persian versions of the Brief Pain Inventory (BPI) interference scale, Roland-Morris Disability Questionnaire (RMDQ), The Hospital Anxiety and Depression Scale (HADS), 36-Item Short Form Survey (SF-36), and General Health Questionnaire-28 (GHQ-28) were used.ResultsAt weeks 4 and 8 after the intervention, all evaluated measures showed significant improvement in both study groups (P < 0.01). The mean improvement of GHQ-28 was 3.7 ± 1.22 in group A and 13.1 ± 4.71 in group B. This difference was statistically significant (P = 0.003). Other outcomes did not vary substantially between the two research groups. Agomelatine treatment was well tolerated, with no significant adverse effects seen in patients. Liver tests of all patients were routine during the study period. Major adverse effect was not seen in any patient. The prevalence of Minor side effects was not significantly different between two study groups.ConclusionCompared with the pregabalin and placebo, co-administration of pregabalin and agomelatine had no added effect on improving pain scores in CLBP patients. However, the patients’ general health was significantly improved after the combined administration of pregabalin and agomelatine.Trial registrationThe study protocol was registered in the Iranian Registry of Clinical Trials before starting the study (NO.IRCT20200620047852N1, Registration date: 23/06/2020).

A Randomized, Double-Blind, Prospective Study to Evaluate the Effect of Oral Pregabalin in Upper Limb Surgeries Under Brachial Plexus Block

ContextThe oral pregabalin administration preoperatively has been reported to reduce acute postoperative pain and prolong the duration of anesthesia produced by single-injection peripheral nerve blockade.AimTo study the effect of single dose pregabalin on duration of brachial plexus blockSettings and designProspective, randomised, double blind, comparative studyMaterial and methodsPatients were divided into two groups (groups A and B), with each group having 50 patients. In group A, the patient received a pregabalin capsule of 300 mg orally two hours before surgery with a sip of water. Group B received a placebo (vitamin B complex capsule) orally two hours before surgery. Brachial plexus block was performed, and data was collected.Statistical analysisData analysis was done using SPSS version 21.0 statistical analysis software. Demographic data and clinical variables were compared using the student's t-test, chi-square test, and Mann-Whitney U test.ResultsThe requirement of the first dose of analgesia was significantly earlier in group B as compared to group A (4:56±0:20 vs. 8:01±0:30 hours). Group B patients, as compared to group A patients, had significantly higher levels of pain after two hours of surgery (0.32±0.47 vs. 0.00±0.00) and at four hours of surgery (2.42±0.50 vs. 0.34±0.59).ConclusionsOral pregabalin prolongs analgesia from brachial plexus block without significant effect on the motor block. In addition, premedication with oral pregabalin increases the sensory block of brachial plexus block.

IMI2-PainCare-BioPain-RCT2 protocol: a randomized, double-blind, placebo-controlled, crossover, multicenter trial in healthy subjects to investigate the effects of lacosamide, pregabalin, and tapentadol on biomarkers of pain processing observed by non-invasive neurophysiological measurements of human spinal cord and brainstem activity

BackgroundIMI2-PainCare-BioPain-RCT2 is one of four similarly designed clinical studies aiming at profiling a set of functional biomarkers of drug effects on specific compartments of the nociceptive system that could serve to accelerate the future development of analgesics. IMI2-PainCare-BioPain-RCT2 will focus on human spinal cord and brainstem activity using biomarkers derived from non-invasive neurophysiological measurements.MethodsThis is a multisite, single-dose, double-blind, randomized, placebo-controlled, 4-period, 4-way crossover, pharmacodynamic (PD) and pharmacokinetic (PK) study in healthy subjects. Neurophysiological biomarkers of spinal and brainstem activity (the RIII flexion reflex, the N13 component of somatosensory evoked potentials (SEP) and the R2 component of the blink reflex) will be recorded before and at three distinct time points after administration of three medications known to act on the nociceptive system (lacosamide, pregabalin, tapentadol), and placebo, given as a single oral dose in separate study periods. Medication effects on neurophysiological measures will be assessed in a clinically relevant hyperalgesic condition (high-frequency electrical stimulation of the skin), and in a non-sensitized normal condition. Patient-reported outcome measures (pain ratings and predictive psychological traits) will also be collected; and blood samples will be taken for pharmacokinetic modelling. A sequentially rejective multiple testing approach will be used with overall alpha error of the primary analysis split between the two primary endpoints, namely the percentage amplitude changes of the RIII area and N13 amplitude under tapentadol. Remaining treatment arm effects on RIII, N13 and R2 recovery cycle are key secondary confirmatory analyses. Complex statistical analyses and PK-PD modelling are exploratory.DiscussionThe RIII component of the flexion reflex is a pure nociceptive spinal reflex widely used for investigating pain processing at the spinal level. It is sensitive to different experimental pain models and to the antinociceptive activity of drugs. The N13 is mediated by large myelinated non-nociceptive fibers and reflects segmental postsynaptic response of wide dynamic range dorsal horn neurons at the level of cervical spinal cord, and it could be therefore sensitive to the action of drugs specifically targeting the dorsal horn. The R2 reflex is mediated by large myelinated non-nociceptive fibers, its circuit consists of a polysynaptic chain lying in the reticular formation of the pons and medulla. The recovery cycle of R2 is widely used for assessing brainstem excitability. For these reasons, IMI2-PainCare-BioPain-RCT2 hypothesizes that spinal and brainstem neurophysiological measures can serve as biomarkers of target engagement of analgesic drugs for future Phase 1 clinical trials. Phase 2 and 3 clinical trials could also benefit from these tools for patient stratification.Trial registrationThis trial was registered on 02 February 2019 in EudraCT (2019-000755-14).

Comparison of pregabalin with magnesium sulfate in the prevention of remifentanil-induced hyperalgesia in patients undergoing rhinoplasty: A randomized clinical trial.

ObjectiveRemifentanil is usually used for controlled hypotension during rhinoplasty under general anesthesia (G/A). One of the complications of the remifentanil is postoperative hyperalgesia. In this study, we compare the effectiveness of pregabalin with that of Mg sulfate in postoperative remifentanil‐induced hyperalgesia prevention.MethodsIn this prospective, randomized, double‐blinded placebo‐controlled trial, 105 patients who candidates rhinoplasty with G/A were enrolled and randomly allocated into three groups. Patients in group A received 300 mg pregabalin before anesthesia. They received physiologic saline infusion during the perioperative period. Those in group B received placebo capsules before anesthesia and intravenous Mg sulfate 30 mg/kg during the perioperative period. Those in group C received a placebo capsule before anesthesia and normal intravenous saline during the operation. Then, pain severity, sedation score, postoperative nausea and vomiting (PONV) were assessed and compared.ResultsIn the Mg sulfate and placebo group, the mean numerical rating scale in the postoperative period was higher compared to the pregabalin group (p < .001). The mean total amount of morphine requirement, meanwhile the 24 h post‐operation, was significantly decreased in the pregabalin group compared to the other groups (p < .001). Participants in the pregabalin group had less PONV compared to those in the pregabalin and placebo groups (p = .015).ConclusionsIn patients undergoing G/A with remifentanil for rhinoplasty, preoperative 300 mg pregabalin could effectively prevent not only remifentanil‐induced hyperalgesia but also PONV.Level of evidence1b.

Comparative Study of the Neurotoxic Effects of Pregabalin Versus Tramadol in Rats

In Egypt, both pregabalin and tramadol misuse increased in the last decade. Although many studies have confirmed the neurotoxic effects of tramadol, those of pregabalin are understudied. The aim of the study is to evaluate the neurotoxic effects of pregabalin compared with tramadol. Thirty male albino rats were included in this experimental study, and they were randomly allocated into three equal groups: group I (normal saline), group II (tramadol misuse), and group III (pregabalin misuse). All rats received the commenced drugs for 1 month. Open field tests were performed on the day of scarification, and after that, cortical samples were taken for immunohistochemical analysis and quantification of dopamine receptors’ gene expression. The drug misuse groups showed a significant decrease in weight gain at the end of the study. Open field testing showed the upper hand of controls regarding all of the tested parameters. Tramadol has a more negative impact on the locomotor parameters compared with pregabalin. Both drugs induced relatively low dopamine-1 receptor (D1Rs) expression to dopamine-2 receptors (D2Rs), mimicking the schizophrenia model. Both tramadol and pregabalin were associated with neurotoxic effects in male albino rats. These effects were less noticed with pregabalin. It is suggested that long-term abuse may end in psychosis.

Comparing the therapeutic effects of pregabalin and gabapentin after transforaminal epidural nerve block in lumbar radiculopathy.

Lumbar radiculopathy can be presented as low back pain and radiating pain. Transforaminal epidural steroid injection (TFESI) has been used to treat radicular pain, and after the injection, additional medications such as gabapentinoids including pregabalin (PGB) and gabapentin (GBP) can be administered to relieve remnant pain. However, little is known about the effectiveness of gabapentinoids in relieving pain after transforaminal epidural steroid injection.This study was conducted to compare the effect of pregabalin and gabapentin in lumbar radiculopathy patients who underwent transforaminal epidural steroid injection.One hundred seven patients who received TFESI and had taken PGB or GBP after the intervention at Daegu Catholic University Medical Center from January 2013 to August 2021 were included in this study. Visual Analogue Scale (VAS) was evaluated in all patients.Among 107 patients, 57 (53.3%) patients took PGB and 50 (46.7%) patients took GBP after TFESI. The PGB and GBP groups showed reduced VAS scores according to visit (P < .001). However, no statistically significant differences in VAS scores according to the types of medication (P = .811) and change aspects according to visit were observed between the PGB and GBP groups (P = .947).The study findings suggest that both pregabalin and gabapentin can be equally used to reduce pain in lumbar radiculopathy patients who underwent TFESI. Further studies with larger sample size are needed to generalize the findings of this study.

Reduction of Acute Postoperative Pain With Pre-Emptive Pregabalin Following Laparoscopic Cholecystectomy

Pregabalin has been considered to be a safe treatment for neuropathic pain. Owing to the lack of research regarding the use of pregabalin in the management of pain in under-resourced settings, our study aimed to deduce the effectiveness of a pre-emptive single dose of pregabalin pre-operatively to provide pain relief after laparoscopic cholecystectomy. Treating acute pain is essential to avoid an increased hospital stay. There is a need for non-opioid drugs with lower risks to avoid using opioids, which lead to many side effects.MethodologyPatients diagnosed with cholelithiasis and scheduled to undergo laparoscopic cholecystectomy at the Abbasi Shaheed Hospital were included in this study. The study aimed to determine whether the effect of pregabalin in combination with patient-controlled analgesia can decrease pain scores. This was a double-blind study where patients, caregivers, and analysts were blinded to group allocation and drugs administered until the data was recorded and sealed. The patients were divided into pregabalin and placebo groups through a web-based model; blocks of four were used and stratification was employed at the center. A confidence interval of 95% was considered significant.ResultsIn our study, a total number of 60 patients were included. They were randomly divided by a computer-based model into two groups, the pregabalin group, and the control group. The placebo group had 33 patients while the pregabalin group had 27 patients. The pregabalin group was given a pregabalin tablet of 150 mg before surgery while the placebo group was given an identical-looking placebo. Patient-controlled analgesia was started in both groups and the visual analog scale (VAS) scoring was observed postoperatively. The pregabalin group had a decreased incidence of pain as compared to the placebo group. There were no significant side effects during the trial; episodes of vomiting were managed using intravenous ondansetron.ConclusionPregabalin is effective in reducing pain in an acute postoperative period when compared with a placebo. Patients who were pre-emptively administered pregabalin reported decreased VAS as compared to the placebo. However, both were inefficient in reducing postoperative nausea and vomiting.

Role of Pregabalin in Reducing Postoperative Analgesic Requirement of Patients Undergoing Knee Arthroscopy Anterior Cruciate Ligament Repair

Objective: To assess the effect of pregabalin in reducing the postoperative requirement of analgesics of patient undergoing knee arthroscopic anterior cruciate ligament repair surgery. Study Design: Prospective randomized control trial. Place and Duration of Study: Department of Anesthesia, Ghurki Trust Teaching Hospital Lahore from 1st June 2021 to 31st December 2021. Methodology: Eighty patients were randomly divided into two groups; group A and group B, each group comprised 40. Group A receive placebo and group B receive pregabalin 150mg once a day for two days after surgery. Pain assessment done with the help of Numeric Rating Scale and rescue analgesia was recorded. Results: The mean age was 31±10.2 years of group A and 33±10.3 year of Group B. There were more males within both groups in comparison to females with a percentage of 77.5% and 85% respectively. The reduction was seen within Group B in comparison of Group A in terms of ASA class, VNRS, and maximum sensory block. Cumulative volume of PCA in ml was also less in group B than group A with a significant difference within 0-6 hours. Conclusions: The use of pregabalin 150mg after surgery for two days significantly reduces the analgesic consumption Keywords: Pregabalin, Postoperative analgesic, Numeric rating scale

Gabapentinoids Suppress Lipopolysaccharide-Induced Interleukin-6 Production in Primary Cell Cultures of the Rat Spinal Dorsal Horn

Introduction: Gabapentin and pregabalin are drugs to treat neuropathic pain. Several studies highlighted effects on presynaptic terminals of nociceptors. Via binding to α₂δ subunits of voltage-gated calcium channels, gabapentinoids modulate the synaptic transmission of nociceptive information. However, recent studies revealed further properties of these substances. Treatment with gabapentin or pregabalin in animal models of neuropathic pain resulted not only in reduced symptoms of hyperalgesia but also in an attenuated activation of glial cells and decreased production of pro-inflammatory mediators in the spinal dorsal horn. Methods: In the present study, we aimed to investigate the impact of gabapentinoids on the inflammatory response of spinal dorsal horn cells, applying the established model of neuro-glial primary cell cultures of the superficial dorsal horn (SDH). We studied effects of gabapentin and pregabalin on lipopolysaccharide (LPS)-induced cytokine release (bioassays), expression of inflammatory marker genes (RT-qPCR), activation of transcription factors (immunocytochemistry), and Ca²⁺ responses of SDH neurons to stimulation with substance P and glutamate (Ca²⁺-imaging). Results: We detected an attenuated LPS-induced expression and release of interleukin-6 by SDH cultures in the presence of gabapentinoids. In addition, a significant main effect of drug treatment was observed for mRNA expression of microsomal prostaglandin E synthase 1 and the inhibitor of nuclear factor kappa B. Nuclear translocation of inflammatory transcription factors in glial cells was not significantly affected by gabapentinoid treatment. Moreover, both substances did not modulate neuronal responses upon stimulation with substance P or glutamate. Conclusion: Our results provide evidence for anti-inflammatory capacities of gabapentinoids on the acute inflammatory response of SDH primary cultures upon LPS stimulation. Such effects may contribute to the pain-relieving effects of gabapentinoids.

A Comparative Study to Analyze the Effect of Gabapentin with Amitriptyline Versus Pregabalin with Amitriptyline in Neuropathic Pain in Cancer Patients Undergoing Palliative Care

Introduction: Antiepileptics and antidepressant medications are known for managing neuropathic pain. We aim to compare the effects of pregabalin with low-dose amitriptyline and gabapentin with low-dose amitriptyline in managing neuropathic pain in cancer patients undergoing palliative care. Materials and Methods: We conducted our study on 160 cancer patients who were having neuropathic pain and were undergoing palliative care treatment in our institute. It was a hospital-based, randomized, tertiary cancer center-based observational study. After taking approval from the institutional ethics committee and taking written informed consent from patients, the patients were divided into two groups and the effect of medicines on incidence of neuropathic pain was observed; the incidence of burning sensation and the incidence of adverse effects of medications were also analyzed. Statistical analysis was done using paired t-test and SPSS version 20 software. Results: The onset of relief in pain was earlier in the pregabalin group as compared to the gabapentin group. There was more reduction in a burning sensation in the pregabalin group as compared to the gabapentin group. The incidence of headaches was the same in both groups. Nausea and vomiting were more in the pregabalin group but the overall difference in adverse effects was not statistically significant (P &gt; 0.05) Conclusions: In the management of neuropathic pain in cancer patients who are undergoing palliative care, a combination of pregabalin with amitriptyline was found to be more effective in pain relief than gabapentin with amitriptyline.

Insilico Identification of H5N1 Avian Influenza Neuraminidase Inhibitors

Background: H5N1 avian influenza virus is influenza-A virus subtype that is highly contagious and fatal among birds and humans. Although human-human transmission of H5N1 is rare, but once the virus has acquired this ability, a devastating pandemic may be inevitable. The virus is currently in WHO phase 3 pandemic alerts: A new influenza virus subtype causing disease in humans, but is yet to spread efficiently and sustainably among humans. Oseltamivir is a single most-win WHO recommended drug for the treatment and prophylaxis of H5N1 influenza virus infection. However, several oseltamivir resistant strains of H5N1 have been reported. Methods: In silico molecular docking algorithm and pharmacophore modelling simulations were used to identify a novel H5N1 avian influenza neuraminidase inhibitors. Results: Of the 518-neuraminidase analogue, five (eflornithine, eltrombopag, entecavir, aminosalicylic acid and pregabalin) demonstrated excellent binding affinities against viral neuraminidase similar to that of oseltamivir. Again, these drugs like oseltamivir interact mainly with arginine, tyrosine and glutamine at different positions of the neuraminidase. Similarly, oseltamivir and the five selected drugs superimpose to the active pocket of neuraminidase, further buttressing the previous findings. Furthermore, oseltamivir and the five drugs had common generated pharmacophores. Conclusion: This study was the first to demonstrate the anti-viral neuraminidase effect of eflornithine, eltrombopag, entecavir, aminosalicylic acid and pregabalin. Keywords: Neuraminidase, Oseltamivir, H5N1 avian influenza, Pharmacophore, molecular docking.

COMPARISON OF THE EFFECTS OF PRE-EMPTIF ANALGESIA PREGABALINE 75 WITH 150 MG ON THE GRADE OF PAIN AND CAESARIAN SECTION SEDATION SCORE WITH SUBARAKHNOID BLOCK

In recent years, many studies have been carried out on the pre-emptive analgesia of pregabalin for various types of surgery with varying results. Preemptive analgesia in caesarean section (SC) usually uses pregabalin at a dose of 150 mg, and there have been no studies using low doses (75 mg) Objective This study aimed to determine the effects of pregabalin 75 mg vs 150 mg doses for controlled pain, their sedation score in patients after C-section under spinal anesthesia. Methods This study was a double-blind randomized trial study examining 20 samples of patients who underwent elective C-sections under spinal anesthesia and divided into 2 equal groups, P75 (who received oral pregabalin 75 mg) and P150 (who received pregabalin 150 mg). The Results There were no significant differences in NRS between the 75 vs 150 mg group (p&gt;0.05), and there were significant differences in Ramsay sedation score between the 75 vs 150 mg group on 2 and 6 hours after surgery(p&lt;0.05) and there were no significant differences about the need for fentanyl rescue between 75 vs 150 mg group (p&gt;0.05). Pregabalin has an opioid-sparing effect and larger doses of pregabalin may increase its efficacy. The sedative effect that arises is due to the mechanism of action of pregabalin which binds potently to the 2δ subunit calcium channel and modulates calcium influx at nerve endings, thereby reducing the release of several excitatory neurotransmitters (glutamate), such as the mechanism of action of various intravenous and inhaled anesthetic agents. Preemptive administration of pregabalin 75 mg is recommended for C-section surgery because it might reduce NRS and the need for fentanyl rescue with minimal sedation side effects.

Risk factors for chronic postsurgical pain in visceral surgery: A matched case-control analysis

Abstract Objective Chronic postsurgical pain (CPSP) is defined as new and persisting pain three months after a surgical procedure, whereby other causes of pain have been excluded. Although CPSP following orthopedic or gynecological surgery has been well investigated, we are lacking data for patients undergoing abdominal visceral surgery. We aim to identify the risk factors for CPSP in this patient population. Methods We performed a retrospective case-control matched analysis including all patients diagnosed with CPSP after abdominal visceral surgery between 2016 and 2019, matched to a control group of patients who did not develop CPSP. Excluded were patients for whom no follow-up was available 3 months or more after surgery. Two-to-one case-control matching was based on operation category (hepato-pancreatico-biliary, upper gastrointestinal, colorectal, transplantation, bariatric and others) and date of surgery. The influence of personal, surgical and pain management factors were explored and multivariate logistic regression analysis was performed. Results 176 patients were diagnosed with CPSP during the study period. They were matched to a sample of 394 control patients extracted from the cohort of 3554 patients without CPSP. The incidence proportion of CPSP was 4.7%. Multivariate logistic regression analysis showed that age under 65 years (OR 2.22, CI 1.34-3.69, p=0.002), preexisting chronic pain of any origin (OR 3.39, CI 2.04-5.62, p=0.000), previous abdominal surgery (OR 1.71, CI 1.07-2.71, p=0.024), acute postoperative pain (2.62, CI 1.55-4.42, p=0.000) and length of stay over three days (OR 2.11, CI 1.26-3.53, p=0.004) were independent risk factors for CPSP. Preoperative Pregabalin intake was protective (OR 0.04, CI 0.01-0.33, p=0.003). Conclusion The identification of these risk factors allows for a preventive and personalized health care approach to our at-risk patients, for whom the optimization of postoperative acute pain management and an additional follow-up consultation 3 months after surgery might be indicated to avoid a delay in diagnosing CPSP. A possible explanation for the protective effect of Pregabalin is that in these patients, preexisting chronic pain might be better controlled in the preoperative phase, and they might have additional follow-up in the postoperative phase, be it from a pain specialist or their general practitioner.

Effect of combination of some Polymers with Carbopol 940 on Pregabalin Release Rate from Emulgels

Topical Emulgels of Pregabalin were formulated using Carbopol 940 in combination with (PVP k90, PEG 200, PEG 1000, HPMC K15M) to obtain the optimal formula in terms of drug release rate. Physical appearance, pH, viscosity, stability, drug content, In-vitro drug release, Differential scanning calorimetry and Fourier transform infrared spectroscopy, were tested in all formulas and evaluated to determine the best one. All formulations had good physical properties and stability, F2 which contains Carbopol 940 0.4% and HPMC K15M 0.4% gave the best drug release rate: (30% in 20 min and 93% in 360 min). But F3 which contains Carbopol 940 0.4% and PEG 200 10% showed the less release rate at 360 min: (64%). F2 showed Korsmeyer–Peppas model Kinetic release. So F2 was the best formula because it released drug since 10 min and still to 360 min (6 hours), thus F2 can be used to obtain rapid analgesic effect and avoid CNS-mediated side effects of Pregabalin.

Comparative evaluation of the hemodynamic effects of inclusion versus exclusion of dexmedetomidine to pregabalin and fentanyl premedication regimen during airway instrumentation in laparoscopic abdominal surgeries

Background: Airway instrumentation leads to an aggravated hemodynamic response due to increased sympathetic activity, imposing a risk of myocardial ischemia. A premedication regimen using fentanyl and pregabalin blunts the pressure response but not the rate response. Objective: To compare the effects of pregabalin and fentanyl regimen versus pregabalin, fentanyl, and dexmedetomidine regimen on the hemodynamic pressor response during airway instrumentation in laparoscopic abdominal surgery (LAS). Methods: Sixty patients (ASA I and II), undergoing elective LASunder general anesthesia, were randomly divided into 2 groups - Group A (n=30) premedicated with oral pregabalin (150mg) and IV fentanyl (2μg/kg) and Group B (n=30) premedicated with IV dexmedetomidine (0.25μg/kg) in addition to pregabalin-fentanyl regimen. Both groups were managed with the same anesthetic protocol. The preoperative sedation level was assessed before induction. The heart rate (HR), systolic and diastolic BP (SBP, DBP), and mean arterial pressure (MAP) were recorded at baseline as well as preoperatively, prior to intubation and at 1, 3, 5, 10, and 15 min after intubation. Results: Both groups had similar distribution of age, weight, gender, physical status, sedation level as well as intra-operative fentanyl and postoperative analgesic requirements.