PAIN+

Martinez V, Pichard X, Fletcher D Perioperative pregabalin administration does not prevent chronic postoperative pain. Systematic review with a meta-analysis of randomized trials. Pain. 2017 Feb 18. doi: 10.1097/j.pain.0000000000000838.
Discipline Area Score
Physician 5 / 7
Abstract

The efficacy of perioperative pregabalin treatment for preventing chronic pain remains a matter of debate. We searched the MEDLINE, EMBASE, LILACS, Cochrane, and Clinical Trial Register databases, and other sources, for randomized controlled trials comparing the effects of pregabalin and placebo. The primary outcome was the incidence of chronic postsurgical pain (CPSP) at 3 months. The secondary endpoints were CPSP at 3, 6, and 12 months and the incidence of chronic postsurgical neuropathic pain at the same time points. A random-effect meta-analysis was performed on the combined data. Evidence quality was rated by the GRADE method. We included 18 studies (2485 patients) in the meta-analysis. Overall, 60% of the trials reporting the primary outcome at 3 months were unpublished; the unpublished trials corresponded to 1492/1884 (79%) of the patients included in these studies. No difference in CPSP incidence between pregabalin and placebo was found at any time point; the risk ratio was 0.87 (0.66, 1.14), I = 57% at 3 months. The evidence was considered to be of moderate quality. Subgroup analysis by publication status, daily dose, type of administration, and type of surgery did not highlight any differences between subgroups. Insufficient data concerning the incidence of chronic postsurgical neuropathic pain were available for any firm recommendation to be made. Pooled data from published and unpublished studies provide no support for the efficacy of pregabalin for preventing CPSP.

Comments from MORE raters

Physician rater

Probably not many will use pregabalin for prevention of chronic postsurgical pain, so this metanalysis will not change clinical practice a lot. However, for me more questions than answers remain, if there are patients and regimens that will benefit from pregabalin administration. Over all, it makes little sense to compare apples with oranges (i.e. hysterectomy vs. TKR or postoperative pain therapy in the control group with acetaminophen vs. epidural) given the fact that there was quite a reduction in RR with the CI going just over 1.

Physician rater

There is paucity of date; it's too heteroginous... the conclusion is not good...

Physician rater

As hospitalists, we get consulted on periop management and post op change in mental status on several patients. Surgeon tend to add medications before surgery to help with pain and specially in older patient group change in mental status is most common reason for consult for our service. Adding medications act on CNS can cause issues and specially agents like pregabalin act on CNS and don't have any reversal agents makes it difficult to manage patients and leads to unnecessary interventions. At the same time, sub group analysis for different age groups and type of surgeries might help. Younger population might be able to tolerate these medications better and might be worth trying - especially while we try to fight the battle of opioid epidemic.
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