Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Evaluation of Preoperative Anxiolytic and Postoperative Analgesic Effects of Pregabalin Premedication
Pregabalin Premedikasyonunun Preoperatif Anksiyolitik ve Postoperatif Analjezik Etkilerinin Değerlendirilmesi
Selma BORA POLATa, İclal ÖZDEMİR KOLa, Onur AVCIa, Ahmet Cemil İŞBİRa, Kenan KAYGUSUZa, Sinan GÜRSOYa
aDepartment of Anesthesiology and Reanimation, Sivas Cumhuriyet University Faculty of Medicine, Sivas, TURKEY
Turkiye Klinikleri J Med Sci. 2019;39(1):9-18
doi: 10.5336/medsci.2018-62181
Article Language: EN
Full Text
ABSTRACT
 Objective: The studies about use of pregabalin for premedication have been recently carried out due to pregabalin has analgesic and anxiolytic effects together. We aimed to evaluate the effects of preoperative pregabalin on anxiety score, hemodynamic parameters, postoperative pain and analgesic consumption in patients undergoing elective abdominal hysterectomy. Material and Methods: The patients were randomly separated into 34 patients of two groups. This prospective randomized, double-blind and placebo-controlled study was performed in patients undergoing elective abdominal hysterectomy. Pregabalin 150 mg (Pregabalin Group) or placebo 150 mg empty capsule (Control Group) was given to the patients 12 hours and 1 hour before operation. STAI-I (State-Trait Anxiety Inventory-I) anxiety scale were performed to the patients during preoperative examination and 1 hour before operation. In both groups, intraoperative hemodynamic parameters, postoperative pain levels with VAS (Visual Analogue Scale), morphine consumption and developing side effects were recorded and analyzed. Results:When all patients were compared from the point of demographic data, no difference was found between groups. STAI-I points were found significantly different between Pregabalin and Control groups both premedication and postmedication phases. MAP (Mean Arterial Pressure) data were found lower in pregabalin group at intraoperative 30th, 40th and 75th minutes and postoperative 1st minute (p<0.05). Postoperative VAS values were found lower in Pregabalin Group. Additional analgesic use and morphine consumption, were lower in Pregabalin group except 1st and 30th minutes. When both groups, examined with regard to side effects, side effect rates of Control Group were 29% and rates of Pregabalin Group were 10%. Conclusion: In this study, it was concluded that pregabalin use at 12 and 1 hour before operation decreased preoperative anxiety score, provided postoperative analgesia and found superior to placebo due to decreasing side effects via decreasing the consumption of analgesics, however for the routine use of pregabalin in premedication it was needed further studies with different doses and large sample sizes.

Keywords: Premedication; postoperative pain; pregabalin; preoperative anxiety
ÖZET
 Amaç: Pregabalinin analjezik ve anksiyolitik etkinliği birarada taşıması nedeniyle son dönemde premedikasyonda kullanımı ile ilgili çalışmalar yapılmaktadır. Elektif abdominal histerektomi geçirecek hastalarda preoperatif pregabalin kullanımının anksiyete skoru, hemodinamik parametreler, postoperatif ağrı ve analjezik tüketimi üzerine etkilerini değerlendirmeyi amaçladık. Gereç ve Yöntemler: Hastalar rastgele 34 kişilik 2 gruba ayrıldı. Bu prospektif randomize, çift kör ve plasebo kontrollü çalışma elektif abdominal histerektomi geçirecek hastalarda gerçekleştirildi. Hastalara operasyondan 12 saat ve 1 saat önce pregabalin 150 mg (Pregabalin grubu) veya plasebo 150 mg boş kapsül (Kontrol grubu) verildi. Hastalara preoperatif muayene sırasında ve operasyondan 1 saat önce State-Trait Anxiety Inventory-I (STAI-I) anksiyete ölçeği uygulandı. Her iki grupta, peroperatif hemodinamik parametreler, VAS ile postoperatif ağrı düzeyleri, morfin tüketimleri ve gelişen yan etkiler kaydedilerek analiz edildi. Bulgular: Tüm hastalar demografik veriler yönünden karşılaştırıldığında gruplararası anlamlı bir fark görülmedi. Pregabalin ve Kontrol grubunda, premedikasyonda ilaç verilmeden önceki ve sonraki STAI-I puanları yönünden gruplararası farklılık anlamlı bulundu. İntraoperatif 30., 45., 75. ve postoperatif 1. dakikadaki OAB (Ortalama Arteryal Basınç) Pregabalin grubunda daha düşük seyretti. Postoperatif VAS (Vizüel Analog Skala) değerleri Pregabalin grubunda daha düşük bulundu. Ek analjezik kullanımı ve morfin tüketimleri 30 dakikadan sonra Pregabalin grubunda daha düşüktü. Her iki grup, yan etki yönünden incelendiğinde Kontrol grubunda %29 yan etki izlenirken, Pregabalin grubunda %10 olarak izlendi. Sonuç: Genel anestezi altında abdominal histerektomi geçirecek hastalarda, operasyondan 12 saat ve 1 saat önce uygulanan 150 mg pregabalinin preoperatif anksiyete skorlarını azalttığı, postoperatif analjezi sağladığı ve analjezik tüketimini azaltarak buna bağlı yan etkileri de azaltması nedeniyle plaseboya üstün olduğu, ancak pregabalinin rutin premedikasyona kazandırılabilmesi için farklı dozlar ve geniş örneklem grupları ile çalışmaların yapılması gerektiği sonucuna varıldı.

Anahtar Kelimeler: Premedikasyon; postoperatif ağrı; pregabalin; preoperatif anksiyete
REFERENCES:
  1. Norris W, Baird WL. Pre-operative anxiety: a study of the incidence and aetiology. Br J Anaesth. 1967;39(6):503-9. [Crossref]
  2. Caumo W, Schmidt AP, Schneider CN, Bergmann J, Iwamoto CW, Adamatti LC, et al. Risk factors for postoperative anxiety in adults. Anaesthesia. 2001;56(8):720-8. [Crossref]
  3. Williams JG, Jones JR. Psychophysiological responses to anesthesia and operation. JAMA. 1968;203(6):415-7. [Crossref]
  4. McClaene GJ, Cooper R. The nature of preoperative anxiety. Anaesthesia. 1990;45(2): 153-5. [Crossref]
  5. Goldmann L, Ogg TW, Levey AB. Hypnosis and day case anaesthesia: a study to reduce preoperative anxiety and intra-operative anaesthetic requirement. Anaesthesia. 1988; 43(6):466-9. [Crossref]
  6. Sağır G, Kaya M, Eskiçırak HE, Kapusuz Ö, Kadıoğulları AN. [The effect of visual information on preoperative anxiety in spinal anesthesia]. Turk J Anesthesiol Reanim. 2012; 40(5):274-8. [Crossref]
  7. Mitchel RVD, Smith G. The control of acute post-operative pain. Br J Anesth. 1988;63:5862.
  8. Stoelting RK, Miller RD. Temel Anestezi. Akkaya T, Ateş Y, Batislam Y, çeviri editörleri. 5. Baskı. Ankara: Güneş Tıp Kitabevleri; 2010. p.168-74.
  9. Kayhan Z. Premedikasyonda kullanılan ilaçlar. Klinik Anestezi. 2. Baskı. İstanbul: Logos Yayıncılık; 1997. p.27-9.
  10. Alkış N. Temel Anestezi. 2. Baskı. Ankara: Güneş Kitabevleri; 2012. p.776-7.
  11. Martin L, Rabasseda X, Leeson P, Castaner J. Pregabalin. Drugs Fut. 1999;24(8):863-5.[Crossref]
  12. Brodie MJ. Pregabalin as adjunctive therapy for partial seizures. Epilepsia. 2004;45 Suppl 6:19-27. [Crossref]
  13. Spielberger CD, Gorsuch RL, Lushene RE, Vagg PR, Jacobs GA. Manual for the StateTrait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press; 1983. p.84.
  14. Gonano C, Latzke D, Sabeti-Aschraf M, Kettner SC, Chiari A, Gustorff B. The anxiolytic effect of pregabalin in outpatients undergoing minor orthopaedic surgery. J Psychopharmacol. 2011;25(2):249-53. [Crossref]
  15. Ho KY, Gan TJ, Habib AS. Gabapentine and postoperative pain--a systematic review of randomized controlled trials. Pain. 2006; 126(1-3):91-101. [Crossref]
  16. Koyuncu T, Oğuz G, Akben S, Nas S, Ünver S. [The effects of pregabaline on postoperative pain and opioid consumption used perioperatively in patients undergoing modified radical mastectomy]. Agri. 2013;25(4):169-78.[Crossref]
  17. Sundar AS, Kodali R, Sulaiman S, Ravullapalli H, Karthekeyan R, Vakamudi M. The effects of preemptive pregabalin on attenuation of stress response to endotracheal intubation and opioid-sparing effect in patients undergoing off-pump coronary artery bypass grafting]. Ann Card Anaesth. 2012;15(1):21-5.
  18. Pyati S, Gan TJ. Perioperative pain management. CNS Drugs. 2007;21(3):185-211. [Crossref]
  19. Güz H, Doğanay Z, Güz T. [Preoperative anxiety on patients undergoing surgery because of lumbar disc hernia]. Nöropsikiatri Arşivi. 2003;40(1-2):36-9.
  20. Ip HY, Abrishami A, Peng PW, Wong J, Chung F. Predictors of postoperative pain and analgesic consumption: a qualitative systematic review. Anesthesiology. 2009;111(3):657-77.[Crossref]
  21. Bockbrader HN, Radulovic LL, Posvar EL, Strand JC, Alvey CW, Busch JA, et al. Clinical pharmacokinetics of pregabalin in healthy volunteers. J Clin Pharmacol. 2010;50(8):941-50.[Crossref]
  22. Salman E, Çelik Ç, Candan S. Premedication with single dose pregabalin 150 mg attenuates hemodynamic response to laryngoscopy and endotracheal intubation. Scientificreports. 2012;1:297. [Crossref]
  23. Eren G, Kozanhan B, Hergünsel O, Bilgin Ü, Demir G, Çukurova Z. Pregabalin blunts cardiovascular response to laryngoscopy and tracheal intubaton. Turkiye Klinikleri J Anest Reanim. 2009;7(2):82-7.
  24. Upendra K, Hemjit T, Khoyumthem P, Khoirom S, Thoibahenba S, Javan NG. A randomized placebo controlled study of preoperative pregabalin on postcholecystectomy pain relief. Journal of Evolution of Medical and Dental Sciences. 2014;3:1573-81. [Crossref]
  25. Pürcü Ö, Yavaşcaoğlu B, Kaya FN, Gurbet A, Türkcan S, Gültekin O. [The effect of pregabalin on analgesia after axillary block]. Turk J Anaesthesiol Reanim. 2013;41(1):18-23.[Crossref]
  26. Rastogi B, Gupta K, Gupta PK, Agarwal S, Jain M, Chauhan H. Oral pregabalin premedication for attenuation of haemodynamic pressor response of airway instrumentation during general anaesthesia: a dose response study. Indian J Anaesth. 2012;56(1):49-54. [Crossref]
  27. Kayhan Z. Klinik Anestezi. 3. Baskı. İstanbul: Logos Yayıncılık Tic AŞ; 2004. p.643-8.
  28. Akarsu T, Tür H, Bolat C, Özkaynak İ. [Comparison of pre-emptive pregabalin with placebo and diclofenac combination for postoperative analgesia and cognitive functions after laparoscopic cholecystectomy]. Turkiye Klinikleri J Med Sci. 2012;32(4):963-70. [Crossref]
  29. Tunç M, Çınar D, Şahin Ş, Sazak H, Köse SK. [The effect of pre-emptive pregabalin on postthoracotomy pain and epidural analgesia]. Türk Göğüs Kalp Damar Cerrahisi Dergisi. 2014;22(1):129-37. [Crossref]
  30. Yücel A, Ozturk E, Aydoğan MS, Durmuş M, Colak C, Ersoy MÖ. Effects of 2 different doses of pregabalin on morphine consumption and pain after abdominal hysterectomy: a randomized, double-blind clinical trial. Curr Ther Res Clin Exp. 2011;72(4):173-83. [Crossref]
  31. Eman A, Bilir A, Beyaz SG. The effects of preoperative pregabalin on postoperative analgesia and morphine consumption after abdominal hysterectomy. Acta Medica Mediterranea. 2014;30:481.
  32. Canihuante J, Molina I, Altermatt F. Is perioperative pregabalin effective for reducing postoperative pain in major surgery? Medwave. 2017;17(9):e7115. [Crossref]
  33. Alimian M, Imani F, Faiz SHR, Pournajafian AR, Navadegi SF, Safari S. Effect of oral pregabalin premedication on post-operative pain in laparoscopic gastric bypass surgery. Anesth Pain Med. 2012;2(1):12-6. [Crossref]

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