The effects of oral pregabalin on post-Lichtenstein herniorrhaphic pain: a randomized clinical trial
-
Mohammad Hossein Moghimi
,
Vahid Salehi
Abstract
Background
Pregabalin is a gamma-aminobutyric acid analog which seems to be effective in different neuropathic pains, as well as in incisional and inflammatory injuries. This study evaluated the effectiveness and safety of pregabalin on pain relief post herniorrhaphy.
Methods
In this randomized clinical trial, 60 men were chosen for unilateral inguinal herniorrhaphy under spinal anesthesia. The participants were randomly divided into two groups. The investigation (pregabalin) group received 300 mg of oral pregabalin 2 h before and 150 mg of pregabalin 12 and 24 h after surgery in addition to routine postoperative medication and 1 mg/kg of pethidine as needed. The control (placebo) group received placebo capsules similar to the investigation group, as well as routine medication and 1 mg/kg of pethidine as needed. All surgeries were done with the same technique. Post-surgery pain was evaluated in the walking and lying positions with a visual analog scale at 12 and 24 h and at 3 and 7 days after the surgery. Pethidine consumption and adverse effects of pregabalin were also assessed.
Results
The investigation group had less pain and lower visual analog scale scores at 12 and 24 h and also at 3 days after surgery and consumed less pethidine compared to the control group (p<0.05).
Conclusions
Pregabalin reduces pain and opioid consumption in the first 3 days after surgery. The adverse effects of pregabalin are limited to the first 12 h after surgery. Pregabalin can be suggested for pain relief, but it should be used with caution in the elderly.
Acknowledgments
The authors would like to thank Seyed Muhammed Hussein Mousavinasab for his sincere cooperation in editing the text.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved the submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
References
1. Wagner JP, Brunicardi FC, Amid PK, Chen DC. Inguinal hernias. In: Brunicardi FC, Andersen D, Billiar T, Dunn D, Hunter JG, Matthews J, editors. Schwartz’s principles of surgery. New York: McGraw-Hill, 2015.Search in Google Scholar
2. Joshi GP, Rawal N, Kehlet H; PROSPECT collaboration, Bonnet F, Camu F, et al. Evidence-based management of postoperative pain in adults undergoing open inguinal hernia surgery. Br J Surg 2012;99:168–85.10.1002/bjs.7660Search in Google Scholar PubMed
3. Callesen T, Bech K, Nielsen R, Andersen J, Hesselfeldt P, Roikjaer O. Pain after groin hernia repair. Br J Surg 1998;85:1412–14.10.1046/j.1365-2168.1998.00864.xSearch in Google Scholar PubMed
4. Joshi GP. Multimodal analgesia techniques and postoperative rehabilitation. Anesthesiol Clin North Am 2005;23:185–202.10.1016/j.atc.2004.11.010Search in Google Scholar PubMed
5. Nienhuijs S, Staal E, Strobbe L, Rosman C, Groenewoud H, Bleichrodt R. Chronic pain after mesh repair of inguinal hernia: a systematic review. Am J Surg 2007;194:394–400.10.1016/j.amjsurg.2007.02.012Search in Google Scholar PubMed
6. Aasvang EK, Gmaehle E, Hansen JB, Gmaehle B, Forman JL, Schwarz J. Predictive risk factors for persistent postherniotomy pain. Anesthesiology 2010;112:957–69.10.1097/ALN.0b013e3181d31ff8Search in Google Scholar PubMed
7. Morrison RS, Flanagan S, Fischberg D, Cintron A, Siu AL. A novel interdisciplinary analgesic program reduces pain and improves function in older adults after orthopedic surgery. J Am Geriatr Soc 2009;57:1–10.10.1111/j.1532-5415.2008.02063.xSearch in Google Scholar PubMed PubMed Central
8. Corke P. Specialist in anesthetics postoperative pain management. Aust Prescr 2013;36:202–5.10.18773/austprescr.2013.079Search in Google Scholar
9. Baidya DK, Agarwal A, Khanna P, Arora MK. Pregabalin in acute and chronic pain. J Anaesthesiol Clin Pharmacol 2011;27:307–14.10.4103/0970-9185.83672Search in Google Scholar PubMed PubMed Central
10. Tiippana EM, Hamunen K, Kontinen VK, Kalso E. Do surgical patients benefit from perioperative gabapentin/pregabalin? A systematic review of efficacy and safety. Anesth Analg 2007;104:1545–56.10.1213/01.ane.0000261517.27532.80Search in Google Scholar PubMed
11. Clarke H, Bonin RP, Orser BA, Englesakis M, Wijeysundera DN, Katz J. The prevention of chronic postsurgical pain using gabapentin and pregabalin: a combined systematic review and meta-analysis. Anesth Analg 2012;115:428–42.10.1213/ANE.0b013e318249d36eSearch in Google Scholar PubMed
12. Partridge B, Chaplan S, Sakamoto E, Yaksh T. Characterization of the effects of gabapentin and 3-isobutyl-g-aminobutyric acid on substance P-induced thermal hyperalgesia. Anesthesiology 1998;88:196–205.10.1097/00000542-199801000-00028Search in Google Scholar PubMed
13. Field MJ, Holloman EF, McCleary S, Hughes J, Singh L. Evaluation of gabapentin and S-(+)-3-isobutylgaba in a rat model of postoperative pain. J Pharmacol Exp Ther 1997;282: 1242–6.10.1016/S0022-3565(24)36908-3Search in Google Scholar
14. Houghton AK, Lu Y, Westlund KN. S-(+)-3-Isobutylgaba and its stereoisomer reduces the amount of inflammation and hyperalgesia in an acute arthritis model in the rat. J Pharmacol Exp Ther 1998;285:533–8.10.1016/S0022-3565(24)37417-8Search in Google Scholar
15. Ho KY, Gan TJ, Habib AS. Gabapentin and postoperative pain – a systematic review of randomized controlled trials. Pain 2006;126:91–101.10.1016/j.pain.2006.06.018Search in Google Scholar PubMed
16. Cabrera Schulmeyer MC, de la Maza J, Ovalle C, Farias C, Vives I. Analgesic effects of a single preoperative dose of pregabalin after laparoscopic sleeve gastrectomy. Obes Surg 2010;20:1678–81.10.1007/s11695-009-9944-1Search in Google Scholar PubMed
17. Chelly JE, Singla N, Lionberger DR, Kehlet H, Sanin L, Sporn J, et al. Use of pregabalin for postoperative pain: outcomes in 2 trials, 2010 ASA Annual Meeting at the San Diego Convention Center in San Diego, California; October 17, 2010.Search in Google Scholar
18. Singla NK, Chelly JE, Lionberger DR, Gimbel J, Sanin L, Sporn J. Pregabalin for the treatment of postoperative pain: results from three controlled trials using different surgical models. J Pain Res 2015;8:9–20.10.2147/JPR.S67841Search in Google Scholar PubMed PubMed Central
19. Brogly N, Wattier JM, Andrieu G, Peres D, Robin E, Kipnis E, et al. Gabapentin attenuates late but not early postoperative pain after thyroidectomy with superficial cervical plexus block. Anesth Analg 2008;107:1720–5.10.1213/ane.0b013e318185cf73Search in Google Scholar PubMed
20. Sen H, Sizlan A, Yanarates O, Emirkadi H, Ozkan S, Dagli G, et al. A comparison of gabapentin and ketamine in acute and chronic pain after hysterectomy. Anesth Analg 2009;109: 1645–50.10.1213/ANE.0b013e3181b65ea0Search in Google Scholar PubMed
21. Moore A, Costello J, Wieczorek P, Shah V, Taddio A, Carvalho JC. Gabapentin improves postcesarean delivery pain management: a randomized, placebo-controlled trial. Anesth Analg 2011;112:167–73.10.1213/ANE.0b013e3181fdf5eeSearch in Google Scholar PubMed
22. Ucak A, Onan B, Sen H, Selcuk I, Turan A, Yilmaz AT. The effects of gabapentin on acute and chronic postoperative pain after coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth 2011;25:824–9.10.1053/j.jvca.2010.11.017Search in Google Scholar PubMed
23. Nikolajsen L, Finnerup NB, Kramp S, Vimtrup AS, Keller J, Jensen TS. A randomized study of the effects of gabapentin on postamputation pain. Anesthesiology 2006;105:1008–15.10.1097/00000542-200611000-00023Search in Google Scholar PubMed
24. Fassoulaki A, Stamatakis E, Petropoulos G, Siafaka I, Hassiakos D, Sarantopoulos C. Gabapentin attenuates late but not acute pain after abdominal hysterectomy. Eur J Anaesthesiol 2006;23:136–41.10.1017/S0265021505002048Search in Google Scholar PubMed
25. Sen H, Sizlan A, Yanarates O, Senol MG, Inangil G, Sücüllü I, et al. The effects of gabapentin on acute and chronic pain after inguinal herniorrhaphy. Eur J Anaesthesiol 2009;26: 772–6.10.1097/EJA.0b013e32832ad2faSearch in Google Scholar PubMed
26. Schmidt PC, Ruchelli G, Mackey SC, Carroll IR. Perioperative gabapentinoids, choice of agent, dose, timing, and effects on chronic postsurgical pain. Anesthesiology 2013;119:1215–21.10.1097/ALN.0b013e3182a9a896Search in Google Scholar PubMed
27. George RB, McKeen DM, Andreou P, Habib AS. A randomized placebo-controlled trial of two doses of pregabalin for postoperative analgesia in patients undergoing abdominal hysterectomy. Can J Anaesth 2014;61:551–7.10.1007/s12630-014-0147-4Search in Google Scholar PubMed
28. Bennett MI, Laird B, van Litsenburg C, Nimour M. Pregabalin for the management of neuropathic pain in adults with cancer: a systematic review of the literature. Pain Med 2013;14:1681–8.10.1111/pme.12212Search in Google Scholar PubMed
29. Cohen SP, Galvagno SM, Plunkett A, Harris D, Kurihara C, Turabi A, et al. A multicenter, randomized, controlled study evaluating preventive etanercept on postoperative pain after inguinal hernia repair. Anesth Analg 2013;116:455–62.10.1213/ANE.0b013e318273f71cSearch in Google Scholar PubMed
30. Othman AH, Zaky AH. Management of hot flushes in breast cancer survivors: comparison between stellate ganglion block and pregabalin. Pain Med 2014;15:410–7.10.1111/pme.12331Search in Google Scholar PubMed
©2018 Walter de Gruyter GmbH, Berlin/Boston
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- Comparative hypoglycemic potentials and phytochemical profiles of 12 common leafy culinary vegetables consumed in Nsukka, Southeastern Nigeria
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- The effects of oral pregabalin on post-Lichtenstein herniorrhaphic pain: a randomized clinical trial
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- Behavior and Neuroprotection
- Haloperidol-induced parkinsonism is attenuated by varenicline in mice
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Articles in the same Issue
- Frontmatter
- Letter to the Editor
- Blister-packed levothyroxine sodium or bottle-packed levothyroxine sodium
- Metabolism
- Comparative hypoglycemic potentials and phytochemical profiles of 12 common leafy culinary vegetables consumed in Nsukka, Southeastern Nigeria
- Infection
- The effects of oral pregabalin on post-Lichtenstein herniorrhaphic pain: a randomized clinical trial
- Cardiovascular Function
- Influence of age and gender on blood pressure variability and baroreflex sensitivity in a healthy population in the Indian sub-continent
- Autonomic responses during acute myocardial infarction in the rat model: implications for arrhythmogenesis
- Phytotherapy
- Role of reactive oxygen species–total antioxidant capacity status in Telfairia occidentalis leaves–associated spermatoprotective effect: a pointer to fatty acids benefit
- Antidiabetic and renoprotective effect of Anogeissus acuminata leaf extract on experimentally induced diabetic nephropathy
- Oxidative Stress
- Aged coconut oil with a high peroxide value induces oxidative stress and tissue damage in mercury-treated rats
- Anti-ulcerogenic effect of the methanol extract of Chasmanthera dependens (Hochst) stem on male Wistar rats
- Hematological Profile
- Evaluation of hematological alterations after therapeutic use of dipyrone in healthy adults: a prospective study
- Hematology and erythrocyte osmotic fragility of the Franquet’s fruit bat (Epomops franqueti)
- Behavior and Neuroprotection
- Haloperidol-induced parkinsonism is attenuated by varenicline in mice
- Antioxidant-mediated neuroprotection by Allium schoenoprasum L. leaf extract against ischemia reperfusion-induced cerebral injury in mice
- Effects of acetone extract of Cola nitida on brain sodium-potassium adenosine triphosphatase activity and spatial memory in healthy and streptozotocin-induced diabetic female Wistar rats
- Case Report
- Conservative treatment of postoperative chylothorax: a case report
- Short Communication
- Improved serotonergic neurotransmission by genistein pretreatment regulates symptoms of obsessive-compulsive disorder in streptozotocin-induced diabetic mice
