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Single low dose preoperative pregabalin induces satisfactory analgesia following laparoscopic cholecystectomy: a randomized double blinded placebo controlled study

Background: Limited supportive evidence, regarding the administration of low dose pregabalin, aimed to reduce pain following laparoscopic cholecystectomy (LC). The analgesic efficacy of a single dose of 75 mg pregabalin versus placebo in patients undergoing elective laparoscopic cholecystectomy with general anesthesia was evaluated.

Methods: The study was conducted on 168 candidates of laparoscopic cholecystectomy. Participants were assigned to one treatment arm with a single dose of 75 mg pregabalin per OS 30 minutes before anesthesia induction (n=84), and one control arm with placebo (n=84). The primary outcome measure was pain intensity measured by visual analog scale at three different time intervals including 4, 6 and 24 hours following anesthesia induction. Patients were educated preoperatively and were asked to rate their pain intensity on ranges of 1-4 (minor), 4-7 (moderate) and 7-10 (severe).

Results: Pain scores did not change over the interval of 4 to 6 hours after surgery. Though, both groups experienced a significant reduction in postoperative pain from 6 to 24 hours following LC. For both 4 and 6 hours following surgery, control patients were 2.9 times (95% CI, [1.2-7.1], P=0.013) more likely to have severe pain as denoted by VAS (7-10). After 24 hours, none of the patients experienced severe pain, however, control patients had significantly higher odds of moderate pain (OR 6.5, 95%CI [3.0-13.5], P<0.001). SPSS, version 18, were used to analyses the date. Shapiro-Wilk test, independent t-test, Pearson Chi-square test and Binary logistic regression were used.

Conclusions: Our findings extend the knowledge of preemptive analgesia and may encourage the use of lower doses of pregabalin to achieve satisfactory short-term pain control in the case of laparoscopic cholecystectomy. Since acute pain after LC peaks within 6 hours of the procedure, the restricted (short term) analgesic effect of low dose pregabalin may be justified.

Author(s): Mansour Choubsaz, Somayeh Mohammadi, Nasrin Amirifard