Effects of pregabalin on post operative morphine consumption and pain after abdominal hysterectomy with/without salphingo-oophorectomy: a randomized, double-blind trial.
BACKGROUND
Achieving post operative pain management is difficult with the use of only opioids analgesia. Multimodal pain management is a method to improve post operative analgesia with minimal side effects. Pregabalin has an analgesic and opioids sparing effects in post operative analgesia.


OBJECTIVE
The objective of the present study was to evaluate the effect of premedication with pregabalin 300 mg compared with lorazepam 0.5 mg on post operative morphine consumption in women undergoing abdominal hysterectomy with/without salphingo-oophorectomy.


METHODS
Eighty ASA I-III, aged 18-65 year patients undergoing elective abdominal hysterectomy with/without salphingo-oophorectomy were randomized to receive either lorazepam 0.5 mg or pregabalin 300 mg 1 hr before surgery. Anesthesia was induced with thiopental (3-5 mg/kg) and atracurium (0.6 mg/kg) and maintained with sevoflurane with a fresh gas flow of 2 L/min (50% N2O in O2) and morphine 0.1-0.2 mg/kg. All patients received patient-controlled analgesia with morphine with a 1 mg incremental dose, 5-min lockout interval, and 4-hr limit of 40 mg post operative. Patients were studied at 0, 1, 4, 12 and 24 hours post operatively for verbal numerical rating scale (VNRS), morphine consumption, satisfaction score and side effects.


RESULTS
The VNRS scores of the pregabalin group were significantly lower than the control group at 1, 4, 12 and 24 hours after surgery. The total morphine consumption at 24 hours post operatively of pregabalin group (7.11 +/- 5.57) was significantly lower than the control group (21.18 +/- 7.12) (p < 0.01). There were no differences between groups in somnolence and dizziness (p = 0.93) and nausea-vomiting (p = 0.11). The satisfaction score was higher in the pregabalin group.


CONCLUSIONS
A 300 mg pregabalin administered 1 hr preoperatively before abdominal hysterectomy with/without salphingo-oophorectomy significantly reduced morphine consumption, VNRS pain score and improved satisfaction score at 24 hr post operatively without any significant differences in side effects. Pregabalin is an alternative combination to opioids as multimodal analgesia.
Ittichaikulthol
Wichai
W
Department of Anesthesiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Virankabutra
Tanit
T
Kunopart
Mutita
M
Khamhom
Wachirapol
W
Putarawuthichai
Pipat
P
Rungphet
Suyawej
S
D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D004311:Double-Blind Method; D005187:Fallopian Tubes / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy; D009020:Morphine / Q000008:administration & dosage*; D010052:Ovariectomy; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D000069583:Pregabalin; D011292:Premedication; D005680:gamma-Aminobutyric Acid / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use
D000700:Analgesics; D000701:Analgesics, Opioid; D000069583:Pregabalin; D005680:gamma-Aminobutyric Acid; D009020:Morphine