Efficacy of pregabalin in acute postoperative pain: a meta-analysis
2011; Elsevier BV; Volume: 107; Issue: 2 Linguagem: Inglês
10.1093/bja/aer207
ISSN1471-6771
Autores Tópico(s)Pain Management and Opioid Use
ResumoEditor'We read with interest the meta-analysis on the efficacy of pregabalin in acute postoperative pain.1Zhang J Ho K-Y Wang Y Efficacy of pregabalin in acute postoperative pain: a meta-analysis.Br J Anaesth. 2011; 106: 454-462doi:10.1093/bja/aer027Abstract Full Text Full Text PDF PubMed Scopus (266) Google Scholar However, we would like to highlight some of our concerns about the study. Although the authors have mentioned about the limitations in their study, it would have been perhaps better if they had performed a subgroup analysis on morphine consumption, depending on the different types of surgery in which pregabalin has been used, because not all operations have the same opioid requirement after operation. In the studies where intraoperative opioids have been given,2Jokela R Ahonen J Tallgren M Haanpaa M Korttila K Premedication with pregabalin 75 or 150 mg with ibuprofen to control pain after day-case gynaecological laparoscopic surgery.Br J Anaesth. 2008; 100: 834-840doi:10.1093/bja/aen098Abstract Full Text Full Text PDF PubMed Scopus (124) Google Scholar, 3Ittichaikulthol W Virankabutra T Kunopart M Khamhom W Putarawuthichai P Rungphet S Effects of pregabalin on postoperative morphine consumption and pain after abdominal hysterectomy with/without salphingo-oophorectomy: a randomized, double-blind trial.J Med Assoc Thai. 2009; 92: 1318-1323PubMed Google Scholar, 4Cabrera Schulmeyer MC de la Maza J Ovalle C Farias C Vives I Analgesic effects of a single preoperative dose of pregabalin after laparoscopic sleeve gastrectomy.Obes Surg. 2010; 20: 1678-1681doi:10.1007/s11695-009-9944-1Crossref PubMed Scopus (66) Google Scholar, 5Mathiesen O Rasmussen ML Dierking G et al.Pregabalin and dexamethasone in combination with paracetamol for postoperative pain control after abdominal hysterectomy. A randomized clinical trial.Acta Anaesthesiol Scand. 2009; 53: 227-235doi:10.1111/j.1399-6576.2008.01821.xCrossref PubMed Scopus (101) Google Scholar, 6Jokela R Ahonen J Tallgren M Haanpaa M Korttila K A randomized controlled trial of perioperative administration of pregabalin for pain after laparoscopic hysterectomy.Pain. 2008; 134: 106-112doi:10.1016/j.pain.2007.04.002Abstract Full Text Full Text PDF PubMed Scopus (137) Google Scholar, 7Agarwal A Gautam S Gupta D Agarwal S Singh PK Singh U Evaluation of a single preoperative dose of pregabalin for attenuation of postoperative pain after laparoscopic cholecystectomy.Br J Anaesth. 2008; 101: 700-704doi:10.1093/bja/aen244Abstract Full Text Full Text PDF PubMed Scopus (171) Google Scholar the authors did not provide a subgroup analysis of whether there was a reduced requirement for intraoperative opioid in the group of patients having had preoperative pregabalin. We found it surprising that the authors chose to analyse opioid consumption where pregabalin had been administered both 1 h before operation and 12 h after operation6Jokela R Ahonen J Tallgren M Haanpaa M Korttila K A randomized controlled trial of perioperative administration of pregabalin for pain after laparoscopic hysterectomy.Pain. 2008; 134: 106-112doi:10.1016/j.pain.2007.04.002Abstract Full Text Full Text PDF PubMed Scopus (137) Google Scholar along with studies2Jokela R Ahonen J Tallgren M Haanpaa M Korttila K Premedication with pregabalin 75 or 150 mg with ibuprofen to control pain after day-case gynaecological laparoscopic surgery.Br J Anaesth. 2008; 100: 834-840doi:10.1093/bja/aen098Abstract Full Text Full Text PDF PubMed Scopus (124) Google Scholar, 3Ittichaikulthol W Virankabutra T Kunopart M Khamhom W Putarawuthichai P Rungphet S Effects of pregabalin on postoperative morphine consumption and pain after abdominal hysterectomy with/without salphingo-oophorectomy: a randomized, double-blind trial.J Med Assoc Thai. 2009; 92: 1318-1323PubMed Google Scholar, 4Cabrera Schulmeyer MC de la Maza J Ovalle C Farias C Vives I Analgesic effects of a single preoperative dose of pregabalin after laparoscopic sleeve gastrectomy.Obes Surg. 2010; 20: 1678-1681doi:10.1007/s11695-009-9944-1Crossref PubMed Scopus (66) Google Scholar, 5Mathiesen O Rasmussen ML Dierking G et al.Pregabalin and dexamethasone in combination with paracetamol for postoperative pain control after abdominal hysterectomy. A randomized clinical trial.Acta Anaesthesiol Scand. 2009; 53: 227-235doi:10.1111/j.1399-6576.2008.01821.xCrossref PubMed Scopus (101) Google Scholar 7Agarwal A Gautam S Gupta D Agarwal S Singh PK Singh U Evaluation of a single preoperative dose of pregabalin for attenuation of postoperative pain after laparoscopic cholecystectomy.Br J Anaesth. 2008; 101: 700-704doi:10.1093/bja/aen244Abstract Full Text Full Text PDF PubMed Scopus (171) Google Scholar in which pregabalin was only administered 1 h before operation. Certainly, these cohorts of patients would have had varying postoperative requirement for opioids. We noted that studies have been included where intraoperative opioids,3Ittichaikulthol W Virankabutra T Kunopart M Khamhom W Putarawuthichai P Rungphet S Effects of pregabalin on postoperative morphine consumption and pain after abdominal hysterectomy with/without salphingo-oophorectomy: a randomized, double-blind trial.J Med Assoc Thai. 2009; 92: 1318-1323PubMed Google Scholar, 4Cabrera Schulmeyer MC de la Maza J Ovalle C Farias C Vives I Analgesic effects of a single preoperative dose of pregabalin after laparoscopic sleeve gastrectomy.Obes Surg. 2010; 20: 1678-1681doi:10.1007/s11695-009-9944-1Crossref PubMed Scopus (66) Google Scholar, 5Mathiesen O Rasmussen ML Dierking G et al.Pregabalin and dexamethasone in combination with paracetamol for postoperative pain control after abdominal hysterectomy. A randomized clinical trial.Acta Anaesthesiol Scand. 2009; 53: 227-235doi:10.1111/j.1399-6576.2008.01821.xCrossref PubMed Scopus (101) Google Scholar 7Agarwal A Gautam S Gupta D Agarwal S Singh PK Singh U Evaluation of a single preoperative dose of pregabalin for attenuation of postoperative pain after laparoscopic cholecystectomy.Br J Anaesth. 2008; 101: 700-704doi:10.1093/bja/aen244Abstract Full Text Full Text PDF PubMed Scopus (171) Google Scholar acetaminophen,8Mathiesen O Jacobsen LS Holm HE et al.Pregabalin and dexamethasone for postoperative pain control: a randomized controlled study in hip arthroplasty.Br J Anaesth. 2008; 101: 535-541doi:10.1093/bja/aen215Abstract Full Text Full Text PDF PubMed Scopus (164) Google Scholar and non-steroidal drugs2Jokela R Ahonen J Tallgren M Haanpaa M Korttila K Premedication with pregabalin 75 or 150 mg with ibuprofen to control pain after day-case gynaecological laparoscopic surgery.Br J Anaesth. 2008; 100: 834-840doi:10.1093/bja/aen098Abstract Full Text Full Text PDF PubMed Scopus (124) Google Scholar 4Cabrera Schulmeyer MC de la Maza J Ovalle C Farias C Vives I Analgesic effects of a single preoperative dose of pregabalin after laparoscopic sleeve gastrectomy.Obes Surg. 2010; 20: 1678-1681doi:10.1007/s11695-009-9944-1Crossref PubMed Scopus (66) Google Scholar have been given either before operation or as an infusion after operation4Cabrera Schulmeyer MC de la Maza J Ovalle C Farias C Vives I Analgesic effects of a single preoperative dose of pregabalin after laparoscopic sleeve gastrectomy.Obes Surg. 2010; 20: 1678-1681doi:10.1007/s11695-009-9944-1Crossref PubMed Scopus (66) Google Scholar and yet a subgroup analysis has not been undertaken to elicit an influence of these analgesics on the efficacy of pregabalin. The authors did not take into consideration the use of ondansetron, droperidol, and dexamethasone,2Jokela R Ahonen J Tallgren M Haanpaa M Korttila K Premedication with pregabalin 75 or 150 mg with ibuprofen to control pain after day-case gynaecological laparoscopic surgery.Br J Anaesth. 2008; 100: 834-840doi:10.1093/bja/aen098Abstract Full Text Full Text PDF PubMed Scopus (124) Google Scholar 6Jokela R Ahonen J Tallgren M Haanpaa M Korttila K A randomized controlled trial of perioperative administration of pregabalin for pain after laparoscopic hysterectomy.Pain. 2008; 134: 106-112doi:10.1016/j.pain.2007.04.002Abstract Full Text Full Text PDF PubMed Scopus (137) Google Scholar while considering the effect on postoperative nausea and vomiting of pregabalin, when all three drugs are known to reduce postoperative nausea and vomiting.9Gan TJ Meyer T Apfel CC et al.Consensus guidelines for managing postoperative nausea and vomiting.Anesth Analg. 2003; 97: 62-71doi:10.1213/01.ANE.0000068580.00245.95Crossref PubMed Scopus (764) Google Scholar The number of patients in the control group in Figures 3 (24 h morphine consumption), 4 (VAS postoperative pain intensity), and 7 (nausea, vomiting, dizziness and headache, and visual disturbance) have been duplicated thereby creating a unit-of-analysis error. This could have been avoided by either splitting the shared group resulting in a smaller sample size and including two or more comparisons, by combining groups to create pair-wise comparisons, or by undertaking a multiple treatment analysis.10J Higgins, S Green, Cochrane Handbook for Systematic Reviews of Interventions, The Cochrane Collaboration(R), Version 5.1.0. Updated March 2011.Google Scholar None declared.
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