1. 2021;24;E501-E510Chronic Pregabalin Treatment and Oxycodone Requirement after Spinal Surgery Versus Short Course Perioperative Administration: A Prospective, Nonrandomized Study
   Prospective Study
   Hélène Beloeil, MD, PhD, Hubert Le Hetet, MD, Bastien Le Touvet, MD, Christophe Aveline, MD, and Alain Le Roux, MD.

BACKGROUND: Although being controversial, pregabalin (PGB) is proposed during a short perioperative period  to improve pain relief.Comparisons between chronic and short-term users during lumbar spine surgery are lacking.

OBJECTIVES: The purpose was to compare opioid requirements and postoperative pain among PGB chronic users and naive patients receiving a 48-hour perioperative administration.

STUDY DESIGN: Prospective nonrandomized study.

SETTING: Tertiary care hospital.

METHODS: Chronic users (group PGB, n = 39) continued their treatment, naive patients (group C, n = 43) received a dose of 150 mg preoperatively and 75 mg/12 hours for 48 hours. Anesthesia and analgesia were standardized. The primary outcome was the cumulative oxycodone consumption at 24 hours, other outcomes included pain scores, DN4 (Douleur Neuropathique 4 Questions) scores, and side effects.

RESULTS: Group PGB consumed less oxycodone at 24 hours (median [interquartile range] 10 mg [10–17.5] vs. 20 mg [10–20], P = 0.013], at 48 hours (15 mg [10–20] vs. 20 mg [12.5–30], P = 0.018), and required less intraoperative remifentanil (P = 0.004). Both groups showed similar pain scores during the 48-hour follow-up and at 3 months.Based on multivariate analysis, chronic users of PGB before surgery exhibited lower oxycodone requirements at 24 hours (odds ratio, 3.98; 95% confidence interval, 1.44–7.74; P = 0.008]. No differences were noted regarding side effects and DN4 scores.

LIMITATIONS: Nonrandomized study.

CONCLUSIONS: Patients chronically treated with PGB required less opioid when compared with a short perioperative administration before spinal surgery. Further prospective studies are required to confirm these results in spinal surgeries.

KEY WORDS: Spinal surgery, pregabalin, postoperative pain, neuropathic pain