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Pregabalin Did Not Improve Pain Management After Spinal Fusions

Abstract

Background

The treatment of postoperative pain is a challenge after posterior spinal fusions. Pain management using predominantly opioids is often associated with multiple adverse effects, while multimodal postoperative analgesia may provide adequate pain relief with fewer opioid side effects.

Questions/Purposes

The purpose of this review is to determine whether addition of 150 mg pregabalin daily would reduce narcotic requirements and improve outcomes after posterior lumbar fusion (PLF).

Methods

The method used is a randomized, controlled trial of elective PLF patients who received pregabalin or placebo. With institutional review board (IRB) approval, 86 patients undergoing elective posterior lumbar fusion, ASA I–III, were randomized to receive either a placebo or pregabalin after obtaining written informed consent. Both arms, i.e., placebo and pregabalin, consisted of 43 patients each.

The 86 patients for elective PLF were randomly assigned to receive 150 mg of pregabalin 1 h before surgery and then 150 mg daily, or a placebo tablet. All patients received a similar general anesthetic and in the post-anesthesia care unit (PACU), started on intravenous (IV) patient-controlled analgesia (PCA) of hydromorphone (0.2 mg/ml). Postoperative pain was assessed daily until discharge using a Numerical Rating Scale (NRS) at rest and with physical therapy (PT). Patients were also assessed twice daily for level of sedation and nausea and/or vomiting and expected PT milestones. All narcotics (IV, oral) were documented.

Results

Demographics and operative time between groups were similar. PCA hydromorphone administration and oral narcotic intake were not statistically different between the two groups. However, an increased incidence of nausea and vomiting in the placebo group reached statistical significance (p < 0.05). In addition, there was no statistical difference between groups with respect to achieving PT milestones and hospital discharge day.

Conclusion

After PLF, patients receiving pregabalin 150 mg/day did not have reduced IV narcotic usage, improved PT milestones, or reduced length of hospital stay. We were unable to demonstrate an analgesic advantage to prescribing pregabalin to patients undergoing lumbar spinal fusions.

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Acknowledgements

We would like to thank Kara Fields, MS, for assistance with data analysis and creating Fig. 2.

Funding

This study was funded by Hospital for Special Surgery Anesthesiology Department Research and Education Fund, New York, NY. REDCap, used to record physical therapy milestone data, was funded by the CTSC grant (grant number UL1 TR000457-06) from the National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD. Pfizer (New York, NY) provided the placebo and pregabalin medications.

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Correspondence to Michael K. Urban MD, PhD.

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Conflicts of Interest

Michael K. Urban, MD, PhD; Kristy M. Labib, MD; Shane C. Reid, MBS, BA; Amanda K. Goon, BA; and Valeria Rotundo have declared that they have no conflict of interest. Frank P. Cammisa Jr., MD reports royalties for patent with NuVasive. Federico P. Girardi, MD reports royalties paid for patents with DePuy Spine, LANX, Inc., NuVasive, and Ortho Development Corp., outside the work.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

Informed Consent

Informed consent was obtained from all patients for being included in the study.

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Disclosure forms provided by the authors are available with the online version of this article.

Additional information

Level of Evidence: Level II: Randomized Controlled Trial.

Work performed at Hospital for Special Surgery, New York, NY.

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Urban, M.K., Labib, K.M., Reid, S.C. et al. Pregabalin Did Not Improve Pain Management After Spinal Fusions. HSS Jrnl 14, 41–46 (2018). https://doi.org/10.1007/s11420-017-9584-2

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Keywords

  • posterior lumbar fusions
  • pregabalin
  • multimodal analgesia
  • postoperative analgesia
  • pain scores after spinal fusions