Peri-operative pregabalin does not reduce pain in adolescents after posterior spinal fusion

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Patients were randomised to receive pregabalin or placebo, prior to posterior spinal fusion surgery

The use of peri-operative pregabalin does not reduce the postoperative opioid consumption or pain scores in adolescents after posterior spinal fusion surgery,  a double-blinded, placebo-controlled, randomised clinical trial has concluded. Findings from the trial, which was authored by Linda Helenius (University of Turku and Turku University Hospital, Turku, Finland) were published online by The Journal of Bone & Joint Surgery.

Helenius and colleagues note that pregabalin as part of a multimodal pain-management regimen has been shown to reduce opioid consumption after spinal surgery in adults but it is unclear whether this is also true in adolescents. The authors also state that pregabalin has been found to have “neuroprotective effects” and therefore could have a positive impact on pain after spinal deformity surgery. The randomised clinical trial sought to evaluate the short-term effects of pregabalin on postoperative pain and opioid consumption, in adolescent patients undergoing spinal fusion.

As part of the trial, adolescents with adolescent idiopathic scoliosis (AIS), Scheuermann kyphosis, or spondylolisthesis who were scheduled for posterior spinal fusion with all-pedicle-screw instrumentation were randomised to receive either pregabalin (2 mg/kg twice daily) or placebo preoperatively and for five days after surgery. The patients ranged from 10–21 years of age. The primary outcome was total opioid consumption as measured with use of patient-controlled analgesia. Postoperative pain scores and opioid-related adverse effects were also evaluated.

Sixty-three of 77 eligible patients were included and analysed in the study. The study team found that cumulative oxycodone consumption per kilogram did not differ between the study groups during the first 48 hours postoperatively, with a median of 1.44 mg/kg (95% confidence interval [CI],1.32 to 1.67 mg/kg) in the pregabalin group and 1.50 mg/kg (95% CI, 1.39 to 1.79 mg/kg) in the placebo group (p = 0.433).

A subgroup analysis of 51 patients with AIS showed the same result, with a mean of 1.45 mg/kg (95% CI, 1.24 to 1.65 mg/kg) in the pregabalin group and 1.59 mg/kg (95% CI, 1.37 to 1.82 mg/kg) in the placebo group (p = 0.289). Total oxycodone consumption per hour (mg/kg/hr) was not different between the groups over the time points (p = 0.752). The postoperative pain scores did not differ significantly between the groups (p = 0.196), the study team found.

Analysis of the findings led the study team to the conclusion that the use of peri-operative pregabalin does not reduce the postoperative opioid consumption or pain scores in adolescents after posterior spinal fusion surgery.


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