Perioperative Pregabalin Improves Postoperative Outcomes after TKA

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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

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Co-Investigators J. Kroin, PhD C. Dellavalle,
MD (orthopedic surgery) M. Kari, MD M. Moric,
PhD K. Tuman, MD Medical school grant from
Pfizer
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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

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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
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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

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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

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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
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Results Epidural Consumption
Epidural analgesic consumption over 24 hours was
less in the pregabalin group versus placebo (P lt
0.0001).
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Results ROM
Active ROM (Plt0.001) was greater in the
pregabalin group versus placebo.
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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

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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
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Conclusion

• The perioperative administration of Pregabalin
  for TKA patients can lead to
• ? Opioid consumption
• ? ROM of the operated Knee both passive and
  active