Perioperative Pregabalin Improves Postoperative Outcomes after TKA - PowerPoint PPT Presentation

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Perioperative Pregabalin Improves Postoperative Outcomes after TKA

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Perioperative Pregabalin Improves Postoperative Outcomes after TKA. Asokumar Buvanendran, MD ... Substance P, Calcitonin Gene-related peptide. Glutamate ... – PowerPoint PPT presentation

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Title: Perioperative Pregabalin Improves Postoperative Outcomes after TKA


1
Perioperative Pregabalin Improves Postoperative
Outcomes after TKA
  • Asokumar Buvanendran, MD
  • Associate Professor
  • Director of Orthopedic Anesthesia
  • Department of Anesthesiology
  • Rush University Medical College
  • Chicago, IL

2
Co-Investigators J. Kroin, PhD C. Dellavalle,
MD (orthopedic surgery) M. Kari, MD M. Moric,
PhD K. Tuman, MD Medical school grant from
Pfizer
3
Mechanism of Analgesia
  • Gabapentin and Pregabalin bind to the
    alpha-2-delta sub-unit of the N-type voltage
    gated calcium channel
  • Same mechanism of action whether it is
    neuropathic pain or inflammatory pain
    (post-surgical)
  • This binding results in ? release of
  • Substance P, Calcitonin Gene-related peptide
  • Glutamate
  • Little effect on normal neuronal tissue, but only
    effective in sensitized neuronal tissue

4
(No Transcript)
5
Pregabalin and Postoperative Pain
  • 3-5 RCT all show
  • ? pain scores
  • Opioid sparing
  • Doses used preop 100-300 mg
  • Doses used postop 75-150 mg

Gilron I Current opinion Anesthesiology 2007
20 456-472
6
RCT Study Design (Level 1)
  • 240 Patients randomized into 2 groups
  • Preop pregabalin 300 mg Postop 150 mg BID for
    10 days and then 75 mg BID and titrated to 50 mg
    and stopped on day 14
  • Preop Placebo Postop Placebo
  • Standard surgery and anesthesia
  • Anesthesia
  • Combined spinal epidural

7
RCT Study Design (Level 1)
  • Outcomes
  • Standard postoperative epidural solution of
    fentanyl Bupivacaine
  • consumption titrated to VAS Acute Pain
  • VAS Scores
  • Sleep Interference
  • ROM of the operated Knee
  • Active
  • Passive

8
Demographics
Treatment group Placebo Pregabalin
Number 120 120
Gender (M/F) 36/84 29/91
Years of Age 65 9 67 8
Weight (kg) 91 26 85 23
Height (cm) 169 9 167 9
Duration of surgery (min) 100.9 31.7 108.6 28.2
Tourniquet time (min) 86.2 40.1 84.0 33.6

Blood loss (mL) 190.4 139.8 163.3 147.1

Total crystalloid (mL) 2515 742 2467 616
9
Results Epidural Consumption
Epidural analgesic consumption over 24 hours was
less in the pregabalin group versus placebo (P lt
0.0001).
10
Results ROM
Active ROM (Plt0.001) was greater in the
pregabalin group versus placebo.
11
Outcomes
  • Passive ROM Postop Day 2
  • Pregabalin 88.9 ? 9.9
  • Placebo 83.7 ? 15.2 P 0.012
  • Sleep Interferance Postop Day 1
  • Pregabalin 2.9 ? 3.3
  • Placebo 4.6 ? 3.2 P 0.035

12
Incidence of Postoperative Adverse Events
Adverse event Placebo Pregabalin P
Confusion 9 15 0.206
Dizziness 16 25 0.103
Sedation 28 35 0.344
Headache 0 2 0.146
Dry mouth 3 10 0.067
Peripheral edema 1 0 0.326
Double vision 0 2 0.147
Itching 13 6 0.110
Nausea 27 17 0.105
Vomiting 24 16 0.223
13
Conclusion
  • The perioperative administration of Pregabalin
    for TKA patients can lead to
  • ? Opioid consumption
  • ? ROM of the operated Knee both passive and
    active
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