The Effect of Perioperative Pregabalin Administration in Postoperative Pain Control After Laminectomy and Instrumented Fusion in Degenerative Lumbar Spine Disease: A Double-Blind, Randomized, Placebo-Controlled Trial

Abstract

Study Design: Randomized controlled trial. Objectives: To evaluate the efficacy of 150 mg and 300 mg preoperative pregabalin for postoperative pain control following lumbar surgery. Summary of Background Data: Pregabalin has been introduced as an adjunct in the multimodal management of pre-emptive and postoperative analgesia following spinal surgery. Previous studies demonstrated its efficacy in neuropathic pain. However, pregabalin's optimal dose, frequency of administration, and efficacy for degenerative lumbar spine surgery have not been previously studied. Methods: Adult patients aged 18 years or older undergoing laminectomy and fusion for degenerative lumbar disease were randomized to receive pregabalin 150 mg, 300 mg, or a placebo presurgery and postsurgery. Metrics included 48-hour postoperative morphine intake, time to first analgesic, pain scores at various postoperative intervals, preoperative and postoperative EQ-5D-3L, and opioid-related side effects. Results: Fifty-four patients were enrolled in the study. Five patients were discontinued. There were no statistical differences in baseline characteristics of patients, except the preoperative EQ-5D, in which the patients who received 300 mg of pregabalin had a higher score than the patients who received placebo. For the primary outcome, there were no statistical differences in the accumulated morphine consumption among the 3 groups during the postoperative periods. The postoperative pain score at 24 hours was the only outcome with a statistically significant difference among the groups (1.1±1.9 for 150 mg of the pregabalin group, 1.4±1.7 for 300 mg of the pregabalin group, and 3.1±2.0 for the placebo group, P=0.007). There were no statistical differences in opioid-related adverse effects among the groups. Conclusion: Preoperative doses of 150 mg or 300 mg of pregabalin did not significantly alter opioid consumption or its side effects compared with a placebo. However, a notable reduction in pain was observed 24 hours postsurgery in the pregabalin groups.