Oral Pregabalin as Premedication on Anxiolysis and Stress Response to Laryngoscopy and Endotracheal Intubation in Patients Undergoing Laparoscopic Cholecystectomy: A Randomized Double-Blind Study

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

Abstract

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.

Methodology

Patients 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.

Results

In 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.

Conclusion

Pregabalin 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.

Some psychiatric comorbidity among patients with substance abuse disorder related to pregabalin

Background

Pregabalin abuse is increasing worldwide and frequently comorbid with another psychiatric disorders including generalized anxiety, major depression, personality disorders, and suicide. Eighty-three patients meeting DSM-IV criteria for substance abuse disorders related to pregabalin were identified from the addiction clinic of El Khanka Psychiatric Hospital in Egypt for this observational cross-sectional study. We aimed to assess clinical characteristics of substance abuse disorder related to pregabalin, suicidal ideation, and psychiatric comorbidities associated with them. All participants were subjected to semi-structured interview designed to collect and identify the sociodemographic data and patterns of substances use, the Structured Clinical Interview for DSM-IV axis I disorders to diagnose comorbid major depression and generalized anxiety, Structured Clinical Interview for DSM-IV axis II disorders for diagnosis of borderline and antisocial personality disorders, Addiction Severity Index, Beck Depressive Inventory, Hamilton Anxiety Rating Scale, and Beck Scale for Suicidal Ideation and urine screening test for pregabalin and other substances.

Results

Forty-seven percent of the studied group had generalized anxiety disorder, 74.7% had major depression disorder, some patients had both major depression and generalized anxiety disorders, 78.3% had borderline personality disorder, 37.3% had antisocial personality disorder, and some patients had both borderline and antisocial personality disorders. There was a statistically significant increase in suicidal ideation among subjects with major depression, generalized anxiety, previous suicidal attempts, and borderline personality disorder.

Conclusions

There is a high comorbidity between pregabalin abuse and major depression disorder, generalized anxiety disorder, borderline personality disorder, and antisocial personality disorder. These psychiatric comorbidities were associated with high risk of suicidal ideations.

Predicting Gag, Discomfort, and Laryngeal Visualization in Patients Undergoing Flexible Laryngoscopy with Stroboscopy

OBJECTIVE

To investigate potential associations between the Predictive Gagging Survey (PGS) with patient experience of gag and discomfort as well as provider perception of patient gag and level of laryngeal visualization during flexible laryngoscopy with stroboscopy (FL-S).

METHODS

A total of 53 adult patients undergoing FL-S were recruited for this prospective non-controlled study. PGS was completed before FL-S. Patients rated perceived level of gag and discomfort on a 10-point severity scale after FL-S. Additionally, providers completed a Gagging Severity Index (GSI) reflecting their impression of patient gag and level of laryngeal visualization following FL-S. Spearman rank correlation coefficients were used to assess associations.

RESULTS

There was a positive association with PGS score and patient perception of gagging (0.34; P = .013) and patient perception of discomfort (0.38; P = .005). No significant association was found between PGS score and provider GSI (-0.12; P = .39) or level of laryngeal visualization (0.15; P = .29). A negative association was found between level of laryngeal visualization and patient perception of gagging (-0.34; P = .012) and discomfort (-0.44; P = .001). No significant differences were found between current and former smokers compared to never smokers for GSI or patient-perceived gag or discomfort.

CONCLUSIONS

While not predictive of GSI or level of laryngeal visualization, the PGS was found to be a useful tool in predicting patient experience of gagging and discomfort during FL-S, further reinforcing the subjective experience of this procedure. Use of the PGS may be helpful in identifying specific candidates who may struggle with subjective discomfort or gagging during FL-S for future studies considering interventions to manage and meaningfully decrease discomfort. Having such an instrument is important given the low number of individuals who struggle with discomfort during the exam.

Preoperative oral pregabalin for anxiety control: a systematic review

OBJECTIVE

The objective of this systematic review was to determine the effectiveness of preoperative oral pregabalin for anxiety control, the most effective dosage regimen, its impact on postoperative pain, and its adverse effects.

MATERIALS AND METHODS

A search was conducted of PubMed/Medline and clinicaltrials.gov (National Library of Medicine, Washington, DC), Scopus, Web of Science, and Cochrane databases for studies published between January 2009 and November 2018, with no language restriction. Based on PRISMA guidelines, the specific question was: is preoperative oral pregabalin effective and safe for anxiety control in patients undergoing surgery? The critical reading of retrieved studies followed questions prepared by the CASPe Network, and their methodological quality was evaluated using the Jadad Scale.

RESULTS

Twelve randomized controlled trials were selected for review. All twelve studies were trials of high quality. A dose of 75 mg preoperative oral pregabalin has been found to reduce anxiety and stabilize intraoperative hemodynamics, although a more significant improvement appears to be achieved with a single dose of 150 mg pregabalin at least 1 h before the surgery. It is not associated with any severe adverse effects.

CONCLUSION

Preoperative administration of oral pregabalin in a single dose of 150 mg appears to be effective to significantly reduce the anxiety of patients, intraoperative hemodynamic changes, and postoperative pain.

CLINICAL RELEVANCE

These findings suggest that pregabalin is useful and safe for preoperative and intraoperative anxiety control in patients undergoing surgery.

Comparative Evaluation of Dexmedetomidine and Pregabalin as Premedication Agent to Attenuate Adverse Hemodynamic and Stress Response in Patients Undergoing Laparoscopic Cholecystectomy

Background:

Laparoscopic cholecystectomy is the most commonly performed laparoscopic procedure. The goal of anesthetic management is to minimize stress response and early discharge. Dexmedetomidine, and pregabalin have been used successfully to attenuate laryngoscopy and intubation response in various surgical procedures.

Aim:

To compare efficacy of pregablin and dexmedetomidine in attenuating hemodynamic and stress response.

Setting and Design:

A prospective, double blind randomized trial comprising 130 ASA physical status class I and II patients posted for laparsoscopic cholecystectomy.

Materials and Methods:

Patients were randomized in to Group A and Group B. Group A received intravenous dexmedetomidine in a dose of 1 ug.kg^-1, through an infusion pump 20 min prior to induction of anaesthesia. Group B subjects received oral pregabalin 150 mg. Parameters observed were vitals, discharge time, cortisol level, side effects if any.

Results:

Post intervention heart rate got reduced significantly in Group A and it remained low in comparison to baseline during whole peri-operative period. In Group B, immediate post-pneumoperitoneum heart rate, and post exubation heart rate was higher than baseline. Blood pressure (BP) decreased significantly post intervention in Group A which persisted till pneumoperitoneum. In Group B there was statistically significant rise in systolic, diastolic and mean blood pressure postpneumoperitoneum as compared to baseline blood pressure. Post-operative cortisol level was significantly higher than baseline values and the level is more in Group B.

Conclusion:

Intravenous dexmedetomidine is more effective than oral pregabalin in attenuating perioperative stress response.

EVALUATION OF PAIN SYNDROME AND EFFICIENCY OF PAIN MANAGEMENT IN LUMBAR SPINE SURGERY

Multimodal analgesia for lumbar spine surgery is still a controversial problem, because of possible fusion problems, significant neuropathic component of pain, and influence of anesthesia type. Aim of the study was to assess the efficacy of pain management after lumbar spine surgery considering characteristics of pain, type of anesthesia and analgesic regimen. Material and methods. 254 ASA I-II patients with degenerative lumbar spine disease were enrolled into prospective study. Patients were operated either under spinal anesthesia (SA) or total intravenous anesthesia (TIVA). In postoperative period patients got either standard pain management (SPM – paracetamol±morphine) or multimodal analgesia (MMA – paracetamol+parecoxib+pregabalin±morphine). Results. We revealed neuropathic pain in 53.9 % of patients, who were elected for lumbar spine surgery. VAS pain score in patients with neuropathic pain was higher, than in patients with nociceptive pain. Total intravenous anesthesia was associated with greater opioid consumption during the first postoperative day. Multimodal analgesia based on paracetamol, parecoxib and pregabalin allowed to decrease requirements for opioids, postoperative nausea and dizziness. Pregabalin used for evening premedication had equipotential anxiolytic effect as phenazepam without postoperative cognitive disturbances. Conclusions. Multimodal analgesia is opioid-sparing technique that allows to decrease complications. Spinal anesthesia is associated to a decreased opioid consumption in the 1st postoperative day.