By Lexa W. Lee
NEW ORLEANS -- October 26, 2009 -- Preoperative pregabalin lowers morphine consumption, the incidence of postoperative nausea and vomiting (PONV), and visual analogue pain scores (VAS) in the first 24 hours after surgery in obese patients who undergo bariatric surgery, according to a study presented here on October 19 at the 2009 Annual Meeting of the American Society of Anesthesologists (ASA).
Obese patients are known to have a low pain threshold; laparoscopic bariatric surgery can result in moderate to severe postoperative pain. Since the use of opioids as anaesthesia is associated with PONV and respiratory depression, the researchers wanted to evaluate how these parameters might be affected by giving preoperative pregabalin to obese patients before laparoscopic bariatric surgery.
According to Maria Carolina Cabrera Schulmeyer, MD, University of Valparaiso, Santiago, Chile, pregabalin is known to decrease pain perception by binding to specific calcium channels in the brain and spinal cord and reducing the release of neurotransmitters.
For the double-blind, prospective, randomised study, 67 patients undergoing laparoscopic bariatric surgery were divided into 2 groups. Mean weight was 104.5 kg. Two hours before surgery, a preoperative dose of pregabalin 150 mg was given to 33 patients and 34 patients received a placebo tablet.
All patients received an intraoperative dose of morphine 0.1 mg kg-1, a 100-mg bolus of ketoprofen, and a 300-mg postoperative infusion of ketoprofen. Hourly VAS and total morphine consumption were measured during the first 24 hours after surgery.
Primary outcomes were the consumption of morphine during the 24-hour period after surgery and the severity of postoperative pain. Secondary outcomes were the incidence of PONV, dizziness, somnolence, sedation, and respiratory depression.
Morphine consumption in the pregabalin group was 11.4 mg in 24 hours, and 23.5 mg in the control group (P < .0001). VAS scores were also significantly lower in the pregabalin group; also, 10 pregabalin-treated patients experienced PONV versus 19 placebo-treated patients (P < .05), and antiemetic consumption was 21% lower in the pregabalin group.
The researchers concluded that 150 mg of pregabalin given 2 hours before laparoscopic bariatric surgery is effective in decreasing morphine consumption, PONV, and VAS in the first 24 hours after surgery in obese patients.
[Presentation title: Analgesic Effects of Preoperative Pregabalin After Laparoscopic Bariatric Surgery. Abstract A793]
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