Effect of Pregabalin Premedication on the Requirement of Anesthetic and Analgesic Drugs in Laparoscopic Cholecystectomy: Randomized Comparison of Two Doses

Impact of chronic medications in the perioperative period -anesthetic implications (Part II)

Background: This review article discusses the pharmacodynamic effects of the most commonly used chronic medications by patients undergoing elective surgical procedures, namely cardiovascular drugs (e.g., beta blockers, alpha-2 agonist, calcium channel blockers, ACE inhibitors, diuretics, etc.), lipid-lowering drugs, gastrointestinal medications (H2-blockers, proton pump inhibitors), pulmonary medications (inhaled β-agonists, anticholinergics,), antibiotics (tetracyclines, clindamycin and macrolide, linezolid.), opioids and non-opioids analgesics (NSAIDs, COX-2 inhibitors, acetaminophen), gabapentanoids, erectile dysfunction (ED) drugs, psychotropic drugs (tricyclic antidepressants [TCAs], monoamine oxidase inhibitors [MAOI], selective serotonin reuptake inhibitors [SSRIs], serotonin norepinephrine reuptake inhibitors [SNRIs], and cannabinol-containing drugs).  In addition, the potential adverse drug-interactions between these chronic medications and commonly used anesthetic drugs during the perioperative period will be reviewed. Finally, recommendations regarding the management of chronic medications during the preoperative period will be provided.Materials and Methods: An online search was conducted from January 2000 through February 2021 with the Medline database through PubMed and Google Scholar using the following search terms/keywords: "chronic medications in the perioperative period", and "chronic medications and anesthetic implications." In addition, we searched for anesthetic side effects associated with the major drug groups.Results and Conclusions: An understanding of the pharmacodynamic effects of most used chronic medications is important to avoid untoward outcomes in the perioperative period. These drug interactions may result in altered efficacy and toxicity of the anesthetic medications administered during surgery. These drug-drug interactions can also affect the morbidity, mortality, recovery time of surgical patients and acute relapse of chronic illnesses which could lead to last minute cancellation of surgical procedures. Part II of this two-part review article focuses on the reported interactions between most commonly taken chronic medications by surgical patients and anesthetic and analgesic drugs, as well as recommendations regarding the handling these chronic medications during the perioperative period.

Premedication with pregabalin 150mg versus 300mg for postoperative pain relief after laparoscopic cholecystectomy

Background and Aims

Pregabalin has been used in various studies for postoperative pain relief in varying doses. However, there is no conclusive evidence to support a safe and effective dose of pregabalin. The present study was designed to compare the efficacy of two different preoperative doses of pregabalin (150 mg and 300mg) in patients undergoing laparoscopic cholecystectomy for postoperative pain relief.

Material and Methods

Ninety adult patients of either sex with American Society of Anesthesiologist physical status I and II scheduled for elective laparoscopic cholecystectomy under general anesthesia were randomized to receive pregabalin 150mg (group A), pregabalin 300mg (group B), or placebo (group C) orally 1 h before surgery. The pain was assessed using a visual analog scale (VAS) and a verbal rating scale (VRS) for the initial 24 h postoperatively. The primary outcome of our study was the comparative assessment of the severity of pain in the postoperative period in three groups. Postoperative analgesic consumption and incidence of side effects were assessed as secondary outcome measures.

Results

VAS score was significantly more in group C than group A and B (P-value <0.05). The total amount of fentanyl required in 24 h was least in group B (228.33 ± 42.41μg) followed by group A (292.50 ± 46.49μg) and group C (322.50 ± 39.58μg) (P-value 0.0001). The incidence of sedation, dizziness, and visual disturbances was more in group B as compared to group A and was least in group C.

Conclusions

Pregabalin 150 mg is effective in decreasing postoperative pain after laparoscopic cholecystectomy with fewer incidences of adverse effects such as sedation and visual disturbances as compared to pregabalin 300 mg.

Evaluation of the Efficacy of Prolonged Pregabalin Administration Before and After Surgery in Patients Undergoing Arthroscopic Anterior Cruciate Ligament Repair: A Prospective, Randomized, Double-blind Study

CONTEXT AND OBJECTIVE

Reconstruction of the knee ligament causes postoperative pain and delayed rehabilitation.

OBJECTIVE

The primary objective of this study was to evaluate the effect of a prolonged preoperative and postoperative pregabalin use for arthroscopic anterior cruciate ligament repair.

MATERIALS AND METHODS

Group 1 (N=25) patients received pregabalin 75 mg/d, and group 2 (N=25) received placebo, 7 days before and 7 days after surgery. Spinal anesthesia was performed using 0.5% hyperbaric bupivacaine (15 mg). The following were evaluated: pain intensity immediately after the surgery, and 12 hours, 24 hours, 1 week, 2 weeks, 1 month, and 2 months after the surgery using a Numerical Rating Scale; dose of postoperative supplementary analgesic for 2 months; time to first analgesic requirement; and side effects during 2 months. For supplementation, the participants received 1 g dipyrone; if there was no pain control, 100 mg ketoprofen was administered; if there was no effect, 100 mg tramadol was administered; and if there was no pain control, 5 mg intravenous morphine was administered until pain control.

RESULTS

There was no difference between the groups with regard to pain intensity (P=0.077). In the pregabalin group, morphine consumption was lower at 12 hours (P=0.039) and 24 hours (P=0.044) after surgery, and the consumption of tramadol and ketoprofen was lower 24 hours after surgery. There was no significant difference in the incidence of nausea and vomiting. Dizziness was higher in the pregabalin group (group 1=12 patients; group 2=3 patients; P=0.005).

DISCUSSION

A prolonged preoperative and postoperative pregabalin prescription for anterior cruciate ligament repair decreased the need for supplementary analgesics during the first 24 postoperative hours but increased dizziness.

Effect of innovative nursing practice on stress response of patients undergoing laparoscopic cholecystectomy

BACKGROUND

Laparoscopic surgery has the advantages of less trauma, less bleeding, fewer complications, and faster postoperative recovery. Although laparoscopic surgery has become mature, many patients still show unique characteristics of high psychological sensitivity and strong surgical stress, and worry about postoperative syndrome, such as poor appetite, diarrhea and so on. The concept of homogeneous medical care is a team jointly established by medical staff to carry out clinical medical care. In this study, the innovative nursing model based on the concept of homogeneous medical care was applied to the actual nursing of patients undergoing cholecystectomy in order to provide a reference for clinical staff.

AIM

To explore the influence of innovative nursing practice on stress response of patients undergoing laparoscopic cholecystectomy.

METHODS

A total of 80 patients who underwent laparoscopic cholecystectomy at Yiwu Central Hospital of Zhejiang Province from April 2017 to April 2019 were selected as the subjects of the study. The patients were randomly divided into either a control group or an observation group with 40 cases each. Both groups were given routine nursing care, such as health education, psychological counseling, diet nursing, preoperative nursing and evaluation, condition nursing, medication nursing, intraoperative and postoperative routine nursing, and vital sign monitoring. The observation group was additionally given innovative nursing care based on the homogeneous medical concept. Changes in stress indicators, including heart rate (HR), mean arterial pressure (MAP), and blood glucose, were observed at one day before surgery (T₀), 10 min after pneumoperitoneum (T₁), and 5 min after surgery (T₂) in the two groups, and venous blood was collected to detect plasma noradrenaline (NE), adrenaline (E), and cortisol levels.

RESULTS

In the control group, HR, MAP, and blood glucose at T₁ and T₂ were all significantly higher than those at T₀ (P < 0.05), but their levels at T₂ were slightly lower those at T1 and still higher than those at T₀ (P < 0.05). The change trends of HR, MAP, and blood glucose in the observation group were similar to those in the control group, but the differences were not statistically significant among different time points (P > 0.05). HR, MAP, and blood glucose at T₁ and T₂ in the observation group were all significantly lower than those in the control group (P < 0.05). Compared with those at T₀, the concentrations of NE, E, and cortisol in the control group significantly increased at T₁ and T₂ (P < 0.05). In the observation group, the concentrations of NE, E, and cortisol increased at T₁ (P < 0.05) and decreased at T₂ (P < 0.05). Compared with the control group, the concentrations of NE, E, and cortisol at T₁ and T₂ were all decreased in the observation group (P < 0.05).

CONCLUSION

Innovative nursing care based on the concept of homogenous medical treatment can significantly reduce the perioperative stress response of patients undergoing laparoscopic cholecystectomy, which is beneficial to promote the postoperative physical recovery of patients.

Hippocampus and cerebellum damage in sepsis induced by lipopolysaccharide in aged rats - Pregabalin can prevent damage

BACKGROUNDS

The aim of this study was to investigate the oxidative damage and inflammatory effects in the hippocampus and cerebellum in lipopolysaccharide (LPS)-induced sepsis model and possible ameliorating effects of pregabalin (PG).

METHODS

Twenty four female Wistar Albino rats (12 month old) were divided into 3 groups as follows: Group I (Control; 0.1 ml/gavage and i.p. saline, single dose), Group II (LPS; 5 mg/kg LPS, i.p, single dose), Group III (LPS + PG; 5 mg/kg LPS, i.p, single dose + 30 mg/kg, gavage, single dose). DNA damage, ischemia-modified albumin (IMA), total oxidant status (TOS), total antioxidant status (TAS) oxidative stress index (OSI), leukocyte (WBC), lymphocyte, neutrophil, hemoglobin (HGB), erythrocyte (RBC), and thrombocyte counts were measured in blood and brain tissues. Histopathological and immunohistochemical evaluation of Caspase- 3, G-CSF, IL-6, SAA, iNOS expressions were conducted using hippocampus and cerebellum tissues.

RESULTS

Comet analysis score, lymphocytes, neutrophils, WBC, IMA, TOS and OSI values were increased in Group II compared with to Group I (p < 0.05). IMA levels in blood, TOS and OSI levels in the brain were significantly decreased in Group III compared to Group II (p < 0.05). We observed increased hemorrhages, neutrophils, leukocytes infiltrations and neuron degeneration in Group II compared to Group I. Caspase 3, G-CSF, IL-6, SAA, iNOS expressions were increased in group II compared to Group I (p < 0.001).

CONCLUSION

Pregabalin partly ameliorated the damage caused by the exposure to LPS in hippocampus and cerebellum; however, further studies are needed to determine pregabalin's possible protective effects at different doses and with different techniques.

Effects of Gabapentinoids Premedication on Shoulder Pain and Rehabilitation Quality after Laparoscopic Cholecystectomy: Pregabalin versus Gabapentin

Introduction

Gabapentinoids are increasingly used in preoperative premedication despite controversial results. The aim of our study was to evaluate the effects of preemptive use of gabapentin or pregabalin on postoperative shoulder pain and rehabilitation quality after laparoscopic cholecystectomy.

Methods

This is a clinical trial comparing the effects of a preoperative premedication with 600 mg of gabapentin or 150 mg of pregabalin versus placebo on postoperative pain and recovery quality after laparoscopic cholecystectomy. Premedication was taken 2 hours before the surgery beginning. Ninety patients were included and randomized into 3 groups (gabapentin, pregabalin, and placebo). The anesthetic protocol was the same for all patients. Primary endpoint was the shoulder pain intensity at the 48th postoperative hour. Secondary endpoints were postoperative nausea and vomiting (PONV), sleep quality during the first night, and the onset time for the first standing position.

Results

During the first 48 postoperative hours, the gabapentin and pregabalin groups had significantly lower shoulder pain than the placebo group (p < 0.05). In gabapentinoids groups, the incidence of PONV was lower and the sleep quality during the first postoperative night was better with significant results. Mean Spiegel scores were 22.43 ± 1.45, 22.30 ± 1.44, and 17.17 ± 1.66, respectively, in pregabalin, gabapentin, and placebo groups (p < 0.05). The delay for the first standing position was 14.9 ± 4.9 hours in the pregabalin group, 9.7 ± 3.6 hours in the gabapentin group, and 21.6 ± 2.1 hours in the placebo group. No superiority was found between gabapentin and pregabalin.

Conclusion

Preemptive premedication with gabapentinoids can enhance postoperative rehabilitation quality after laparoscopic cholecystectomy by reducing postoperative shoulder pain, decreasing PONV incidence, and improving sleep quality during the first postoperative night. This trial is registered with ClinicalTrial.gov (NCT03241875).