title: The Effect of Preoperative Pregabalin on Postoperative Nausea and Vomiting: A Meta-analysis.
abstract: Nonopioid adjuvant medications are increasingly included among perioperative Enhanced Recovery After Surgery protocols. Preoperative pregabalin has been shown to improve postoperative pain and limit reliance on opioid analgesia. Our group investigated the ability of preoperative pregabalin to also prevent postoperative nausea and vomiting (PONV).
  
  
  
  Our group performed a meta-analysis of randomized trials that report outcomes on the effect of preoperative pregabalin on PONV endpoints in patients undergoing general anesthesia.
  
  
  
  Among all included trials (23 trials; n = 1693), preoperative pregabalin was associated with a significant reduction in PONV (risk ratio [RR] = 0.53; 95% confidence interval [CI], 0.39-0.73; P = 0.0001), nausea (RR = 0.62; 95% CI, 0.46-0.83; P = 0.002), and vomiting (RR = 0.68; 95% CI, 0.52-0.88; P = 0.003) at 24 hours. Subgroup analysis designed to account for major PONV confounders, including the exclusion trials with repeat dosing, thiopental induction, nitrous oxide maintenance, and prophylactic antiemetics and including high-risk surgery, resulted in similar antiemetic efficacy. Preoperative pregabalin is also associated with significantly increased rates of postoperative visual disturbance (RR = 3.11; 95% CI, 1.34-7.21; P = 0.008) compared with a control.
  
  
  
  Preoperative pregabalin is associated with significant reduction of PONV and should not only be considered as part of a multimodal approach to postoperative analgesia but also for prevention of PONV.
authors.affiliation: From *The Johns Hopkins Medical Institutions, Baltimore, Maryland; †Vanderbilt University Hospital, Nashville, Tennessee; and ‡Hospital Universitario del Valle, Universidad del Valle, Valle del Cauca, Colombia.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Grant
authors.forename: Matthew
authors.initials: M
authors.lastname: Betz
authors.forename: Matthew
authors.initials: M
authors.lastname: Hulse
authors.forename: Andres
authors.initials: A
authors.lastname: Zorrilla-Vaca
authors.forename: Deborah
authors.initials: D
authors.lastname: Hobson
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Wick
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Wu
mesh_terms: D000700:Analgesics / Q000008:administration & dosage*; D006801:Humans; D020250:Postoperative Nausea and Vomiting / Q000175:diagnosis / Q000188:drug therapy* / Q000517:prevention & control; D000069583:Pregabalin / Q000008:administration & dosage*; D011300:Preoperative Care / Q000379:methods*; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D000069583:Pregabalin