Perioperative Pregabalin for Postoperative Pain Relief after Thoracotomy

Background: Pregabalin is efective both at controlling postoperative pain and preventing chronic neuropathic pain. Local anaesthetic iniltration is a simple and inexpensive method to provide postoperative analgesia. In this study we tested the hypothesis that pregabalin administered perioperatively combined with continuous wound infusion will aid better the post-thoracotomy pain management compared to pregabalin monotherapy. Methods: Forty ive patients received either placebo (PLCB), pregabalin (PRG) or pregabalin and continuous wound infusion (PRG + CWI) of local anaesthetics. Postoperative data collection included opioid consumption, VAS scores at rest and during cough. At 1 and 3 months from surgery patients were assessed with the DN4 questionnaire for neuropathic pain. Results: VAS scores were signiicantly lower in the PRG+CWI group (p < 0.05) at rest while during cough the placebo group had higher scores than both treatment groups (p < 0.001 or p < 0.05). Morphine consumption measured at 48 hr PO revealed a signiicant diference in total morphine; PLCB: 49 ±11mg, PRG: 33 ±10mg and PRG+CWI: 28 ±11mg (p < 0.001 between placebo and the other two groups). The incidence of neuropathic pain was more frequent in the placebo group (1-month: PLCB: 10 pt, PRG: 0 pt and PRG+ CWI: 0 pt (p < 0.001), 3 months: PLCB: 10 pts, PRG: 0 pt and PRG+ CWI: 0 pt (p < 0.001)). Conclusions: Perioperative administration of pregabalin signiicantly reduces pain scores, opioid consumption and incidence of neuropathic pain in post-thoracotomy patients. The addition of continuous wound iniltration of local anaesthetics although improved immediate postoperative analgesia at rest did not afect diferently the development of neuropathic pain. Corresponding author: Tatiana Sidiropoulou, Second Department of Anaesthesiology, University of Athens, Attikon Hospital, Rimini 1, Haidari, 12462, Athens, Greece, E-mail: [email protected]