PREOPERATİF AĞRI YÖNETİMİNDE PREGABALİNİN ROLÜ: ETKİ MEKANİZMALARI VE KLİNİK SONUÇLAR

Öz

Amaç: İnfraklaviküler blok, el ve ön kol cerrahisinde yaygın olarak kullanılan bir tekniktir. Nöropatik ve kronik ağrı üzerine etkinliği bilinen pregabalin, preoperatif uygulandığında postoperatif ağrıyı azaltmak için potansiyel bir ajan olarak ortaya çıkmıştır. Bu çalışma, ameliyattan bir saat önce uygulanan tek doz 150 mg pregabalinin, infraklaviküler blok ile el ve ön kol cerrahisi geçiren hastalarda blok özellikleri ve postoperatif analjezi gereksinimi üzerindeki etkisini değerlendirmeyi amaçlamıştır. Yöntem: İnfraklaviküler blok altında el ve ön kol cerrahisi geçiren ASA I-II olarak sınıflandırılan 18-65 yaş arası hastaların tıbbi kayıtları retrospektif olarak analiz edildi. Olguların tamamına bölge antisepsisi sağlanarak 30 ml volüm (Bupivakain+Lidokain) verilerek ultrasonografi eşliğinde infraklavikuler blok yapıldı. Hastalar iki gruba ayrıldı: 150 mg pregabalin ile preemptif anestezi alan 30 hastadan oluşan pregabalin grubu (Grup P) ve pregabalin almayan 30 hastadan oluşan kontrol grubu (Grup C). Hemodinamik parametreler, postoperatif ağrı yoğunluğu, ilk ağrı başlangıç zamanı ve ilk analjezik gereksinimi zamanı anestezi kayıtları ve hasta takip formlarına dayanarak belgelendi. Bulgular: Postoperatif vizüel analog skala skorlaru Grup P'de 12. ve 24. saatlerde daha düşüktü (p<0,05). İlk analjezik uygulama süresi Grup P'de Grup C'ye kıyasla önemli ölçüde daha uzundu. Sonuç: Ameliyattan bir saat önce uygulanan tek doz 150 mg pregabalin, periferik rejyonel blok ile ameliyata giren hastalarda postoperatif ağrıyı ve analjezik gereksinimini azaltmaktadır. Anahtar Kelimeler: İnfraklaviküler blok, postoperatif ağrı, preempeitif analjezi, pregabalin

Anahtar Kelimeler

• İnfraklaviküler blok
• postoperatif ağrı
• preemptif analjezi
• pregabalin

RETROSPECTIVE REVIEW OF THE ROLE OF PREGABALIN IN PREOPERATIVE PAIN MANAGEMENT: MECHANISMS OF ACTION AND CLINICAL OUTCOMES

Öz

Objective: Infraclavicular block is a commonly utilized technique in hand and forearm surgeries. Pregabalin, acknowledged for its efficacy in managing neuropathic and chronic pain, has emerged as a potential intervention for reducing postoperative pain when administered preoperatively. This study aimed to evaluate the impact of a single 150 mg dose of pregabalin, administered one hour prior to surgery, on block characteristics and postoperative analgesia requirement in patients undergoing hand and forearm surgery with infraclavicular block. Methods: The medical records of patients aged 18-65 years, classified as ASA I-II, who underwent hand and forearm surgeries under infraclavicular block, were retrospectively analyzed. All patients received regional antisepsis, a 30 ml volume (Bupivacaine+Lidocaine) was administered, and an ultrasound-guided infraclavicular block was performed. Patients were categorized into two groups: the pregabalin group (Group P), comprising 30 patients who received preemptive anesthesia with 150 mg pregabalin, and the control group (Group C), consisting of 30 patients who did not receive pregabalin. Hemodynamic parameters, postoperative pain intensity, time of initial pain onset, and time of first analgesic requirement were documented based on anesthesia records and patient follow-up forms. Results: Postoperative visual analog scale scores were lower in Group P at the 12th and 24th hours (p<0.05). The time to the first analgesic application was significantly longer in Group P compared to Group C. Conclusion: A single dose of 150 mg pregabalin administered one hour before surgery appears to reduce postoperative pain and analgesic requirements in patients undergoing surgery with peripheral regional block.

Anahtar Kelimeler

• Infraclavicular block
• postoperative pain
• preemptive analgesia
• pregabalin

Kaynakça

1. Xuan C, Yan W, Wang D, et al. Efficacy of preemptive analgesia treatments for the management of postoperative pain: a network meta-analysis. Br J Anaesth. 2022;129(6):946-58. doi:10.1016/j.bja.2022.08.038
2. Çağıran E, Eyigör C, Sezer B, Uyar M. Preemptive analgesic efficacy of dexketoprofen trometamol on impacted third molar surgery. Agri. 2014;26(1):29-33. doi:10.5505/agri.2014.55265
3. Van Backer JT, Jordan MR, Leahy DT, et al. Preemptive analgesia decreases pain following anorectal surgery: a prospective, randomized, double-blinded, placebo-controlled trial. Dis Colon Rectum. 2018;61(7):824-9. doi:10.1097/DCR.0000000000001069
4. Reyes Fernandez PC, Wright CS, Warden SJ, Hum J, Farach-Carson MC, Thompson WR. Effects of Gabapentin and Pregabalin on Calcium Homeostasis: Implications for Physical Rehabilitation of Musculoskeletal Tissues. Curr Osteoporos Rep. 2022;20(6):365-378. doi:10.1007/s11914-022-00750-x
5. Toth C. Pregabalin: latest safety evidence and clinical implications for the management of neuropathic pain. Ther Adv Drug Saf. 2014;5(1):38-56. doi:10.1177/2042098613505614
6. Bach DR, Korn CW, Vunder J, Bantel A. Effect of valproate and pregabalin on human anxiety-like behaviour in a randomised controlled trial. Transl psychiatry. 2018;8(1):157. doi:10.1038/s41398-018-0206-7
7. Hamada NM, Ashour RH, Shalaby AA, El-Beltagi HM. Calcitonin potentiates the anticonvulsant and antinociceptive effects of valproic acid and pregabalin in pentylenetetrazole-kindled mice. Eur J Pharmacol. 2018;818:351-5. doi:10.1016/j.ejphar.2017.11.003
8. Polat SB, Kol IÖ, Avci O, Işbir AC, Kaygusuz K, Gürsoy S. Evaluation of preoperative anxiolytic and postoperative analgesic effects of pregabalin premedication. Turkiye Klinikleri J Med Sci. 2019;39(1):9-18. doi:10.5336/medsci.2018-62181

9. Çiçekci F, Sargin M, Yildirim A, Körez MK, Günaydin G, İnci K. The Efficacy Of Preemptive Pregabalİn Administration on Pre-and Postoperative Anxiety and Postoperative Analgesia in Arthroscopic Shoulder Surgery: A Prospective, Randomized, Double-Blind, Placebo-Controlled Clinical Study. The Journal of General Medicine. 2022;32(1):12-8. doi:10.54005/geneltip.999386
10. Richebé P, Capdevila X, Rivat C. Persistent Postsurgical Pain: Pathophysiology and Preventative Pharmacologic Considerations. Anesthesiology. 2018;129(3):590-607. doi:10.1097/ALN.0000000000002238
11. Li QB, Chang L, Ye F, Luo QH, Tao YX, Shu HH. Role of spinal cyclooxygenase-2 and prostaglandin E2 in fentanyl-induced hyperalgesia in rats. Br J Anaesth. 2018;120(4):827-835. doi:10.1016/j.bja.2017.11.103
12. Mathieson S, Lin CC, Underwood M, Eldabe S. Pregabalin and gabapentin for pain. BMJ. 2020;369:m1315. doi:10.1136/bmj.m1315
13. Xuan C, Yan W, Wang D, et al. Efficacy of preemptive analgesia treatments for the management of postoperative pain: a network meta-analysis. Br J Anaesth. 2022;129(6):946-958. doi:10.1016/j.bja.2022.08.038
14. Calandre EP, Rico-Villademoros F, Slim M. Alpha2delta ligands, gabapentin, pregabalin and mirogabalin: a review of their clinical pharmacology and therapeutic use. Expert Rev Neurother. 2016;16(11):1263-1277. doi:10.1080/14737175.2016.1202764
15. Byrne K, Smith C. Preemptive Analgesia: An Unobtainable Goal?. J Cardiothorac Vasc Anesth 2019;33(2):460-1.
16. Chung SW, Chung SH, Kim DH, et al. Effect of Gabapentin on Tendon-to-Bone Healing in a Rat Model of Rotator Cuff Repair. Orthopedics. 2024;47(5):e241-e246. doi:10.3928/01477447-20240718-01
17. Kharasch ED, Clark JD, Kheterpal S. Perioperative Gabapentinoids: Deflating the Bubble. Anesthesiology. 2020;133(2):251-254. doi:10.1097/ALN.0000000000003394
18. Patel AS, Abrecht CR, Urman RD. Gabapentinoid use in perioperative care and current controversies. Curr Pain Headache Rep. 2022;26(2):139-44. doi:10.1007/s11916-022-01012-2
19. Wang Y, Guo X, Guo Z, Xu M. Preemptive analgesia with a single low dose of intrathecal morphine in multilevel posterior lumbar interbody fusion surgery: a double-blind, randomized, controlled trial. Spine J. 2020;20(7):989-997. doi:10.1016/j.spinee.2020.03.001
20. Rodrigues GA, Hizatugu R, Bronzato JD, de-Jesus-Soares A, Frozoni M. Effect of preemptive use of a nonsteroidal anti-inflammatory drug and a corticosteroid on the efficacy of inferior alveolar nerve blockade and postoperative pain control in endodontic treatment of molars with symptomatic pulpitis: A randomized double-blind placebo-controlled clinical trial. Int Endod J. 2024;57(5):520-532. doi:10.1111/iej.14030
21. Medeiros-Albuquerque AF, Roriz-Fonteles CS, do Nascimento-Costa JJ, et al. RT-qPCR study of COX-1 and -2 genes in oral surgical model comparing single-dose preemptive ibuprofen and etoricoxib: A randomized clinical trialy. J Clin Exp Dent. 2020;12(4):e371-e380. doi:10.4317/jced.56447
22. Zhang J HK, Wang Y. Efficacy of pregabalin in acute postoperative pain: a meta-analysis. Br J Anaesth. 2011;106(4):454-62. doi:10.1093/bja/aer027
23. Zhou Y, Sun W, Fu Y, et al. Effect of esketamine combined with pregabalin on acute postsurgical pain in patients who underwent resection of spinal neoplasms: a randomized controlled trial. Pain. 2024;165(9):e96-e105. doi:10.1097/j.pain.0000000000003211
24. Tsai SHL, Hu CW, El Sammak S, et al. Different Gabapentin and Pregabalin Dosages for Perioperative Pain Control in Patients Undergoing Spine Surgery: A Systematic Review and Network Meta-Analysis. JAMA Netw Open. 2023;6(8):e2328121. doi:10.1001/jamanetworkopen.2023.28121
25. Nozawa K, Karasawa Y, Shidahara Y, Ushida T. Efficacy of Combination Therapy with Pregabalin in Neuropathic Pain: A Preclinical Study in the Rat L5 Spinal Nerve Ligation Model. J Pain Res. 2022;15:3469-3478. doi:10.2147/JPR.S383981
26. Tesfaye S, Sloan G, Petrie J, et al. Comparison of amitriptyline supplemented with pregabalin, pregabalin supplemented with amitriptyline, and duloxetine supplemented with pregabalin for the treatment of diabetic peripheral neuropathic pain (OPTION-DM): a multicentre, double-blind, randomised crossover trial. Lancet. 2022;27;400(10353):680-690. doi:10.1016/S0140-6736(22)01472-6
27. Tesfaye S, Wilhelm S, Lledo A, et al. Duloxetine and pregabalin: high-dose monotherapy or their combination? The "COMBO-DN study"--a multinational, randomized, double-blind, parallel-group study in patients with diabetic peripheral neuropathic pain. Pain. 2013;154(12):2616-2625. doi:10.1016/j.pain.2013.05.043
28. Spreng UJ, Dahl V, Raeder J. Effect of a single dose of pregabalin on post-operative pain and pre-operative anxiety in patients undergoing discectomy. Acta Anaesthesiol Scand. 2011;55(5):571-6. doi:10.1111/j.1399-6576.2011.02410.x
29. Kim JC CY, Kim KNK. Effective dose of peri-operative oral pregabalin as an adjunct to multimodal analgesic regimen in lumbar spinal fusion surgery. Spine. 2011;36:428-33. doi:10.1097/BRS.0b013e3181d26708
30. Bonnet U, Scherbaum N. How addictive are gabapentin and pregabalin? A systematic review. Eur Neuropsychopharmacol. 2017;27(12):1185-1215. doi:10.1016/j.euroneuro.2017.08.430
31. Schulmeyer MCC MJ, Ovalle C. Analgesic effects of a single preoperative dose of pregabalin after laparoscopic sleeve gastrectomy. Obes Surg. 2010;20:1678-81. doi:10.1007/s11695-009-9944-1
32. Park KH, Chung NS, Chung HW, Kim TY, Lee HD. Pregabalin as an effective treatment for acute postoperative pain following spinal surgery without major side effects: protocol for a prospective, randomized controlled, double-blinded trial. Trials. 2023;24(1):422. doi:10.1186/s13063-023-07438-2
33. Moore RA SS, Wiffen PJ. Pregabalin for acute and chronic pain in adults. Ann Intem Med. 2009;151:JC6-7. doi:10.1002/14651858.CD007076.pub2
34. Pürcü Ö, Yavascaoglu B, Kaya FN, Gurbet A, Türkcan S, Orhan G. Effects of pregabalin on postoperative analgesia after axillary block. Turk J Anaesthesiol Reanim. 2013;41(1):18. doi:10.5152/TJAR.2013.04