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Laparoscopic cholecystectomy is one of most popular surgical procedures however; pain after this surgery presents a major challenge. It is most intense on the day of surgery and on the following day and subsequently declines to lower levels within 3–4 days. Intense acute pain after laparoscopic cholecystectomy might predict the development of chronic pain (e.g. post-laparoscopic cholecystectomy syndrome).
Several medications have been used to treat postoperative pain. Opioid are the most commonly used but has been associated with emesis, respiratory depression and altered mental status. Non-steroidal anti-inflammatory drugs (NSAIDs) are frequently used however; they are linked with the risk of allergy, kidney damage, bleeding and gastrointestinal dysfunction. Another alternative is the use of local anesthetics though; they require interventional procedures and most of them are short or intermediate acting. A multimodal approach has been suggested to improve postoperative analgesia and to reduce the above mentioned side effects.
The aim of this study was to evaluate the efficacy and tolerability of Pregabalin in postoperative pain management after laparoscopic cholecystectomy.
This study was a randomized, placebo, controlled study conducted at the Anesthesia Department, Laparoscopy Surgery Unit, Ain Shams University Hospital. Ninty patients with ASA physical status I - II scheduled for elective laparoscopic cholecystectomy under general anesthesia were included. Patients were randomly assigned to the following groups (n=30 each); Pregabalin group [P]: received 150mg pregabalin capsules two hours preoperative and 12 hours postoperative and twice daily for 2 days, Gabapentin group [G]; received 1200 mg gabapentin capsules 400 mg two hours preoperative and 12 hours postoperative and 400mg three times daily for 2 days, Control group [C]; received placebo capsules. Postoperative pain scores were recorded on a visual analogue scale (VAS). The following data was recorded; total daily pethidine and diclofenac consumption, numeric sedation score and the postoperative nausea, vomiting and dizziness scores.
The 24 hour-pethidine consumption was significantly lower (p<0.001) in both Pregabalin and Gabapentine groups versus control. Both groups had significantly less (p<0.001) patients with postoperative nausea, vomiting, sedation and dizziness versus control. Overall patient satisfaction with pain management was significantly higher (p<0.001) in Pregabalin group versus gabapentin or control groups.
The perioperative oral administration of Pregabalin 150 mg in patients undergoing laparoscopic cholecystectomy is an effective and safe method of analgesia with a low incidence of adverse effects and reduces postoperative opioids consumption and improves patients’ satisfaction.