Preoperative oral pregabalin for anxiety control: a systematic review

Comparison of Pregabalin and Midazolam as Premedication in Children Undergoing General Anesthesia for Dental Treatment

Background

Pediatric dentists employ both pharmacological and non-pharmacological behavior control methods. Despite the use of behavioral control techniques, some young children cannot undergo treatment in the office, making sedation or general anesthesia necessary. Premedication drugs can be used before general anesthesia to reduce anxiety, control pain, induce amnesia, prevent nausea, and avert potential complications. The search for the ideal premedication for children is ongoing.

Objectives

This study aims to compare the effects of pregabalin and midazolam (MID) in children undergoing dental treatment under general anesthesia.

Methods

This prospective, triple-blind study included 64 children aged 2 - 6 years who required dental treatment under general anesthesia. Participants who met the inclusion criteria were enrolled. One group of children received pregabalin syrup, while the other group received MID syrup. The comfort of the child during separation from the parents, ease of venous access, and degree of sedation upon entering the operating room were evaluated. Blood pressure, heart rate, and blood oxygen levels were measured at baseline and every 30 minutes thereafter. Additionally, the duration of the patient's stay in recovery until discharge was recorded and compared between the two groups. Statistical analyses were performed using chi-square, Mann-Whitney U, Fisher's exact test, and SPSS version 14 software.

Results

No statistically significant differences were found between premedication with MID and pregabalin in terms of anxiety during venous access, parental separation anxiety, restlessness in recovery, duration of recovery stay, or changes in heart rate, blood pressure, and blood oxygen levels between the two groups. However, a statistically significant difference was observed between the two groups regarding the degree of sedation before entering the operating room.

Conclusions

Both pregabalin and MID were effective for premedication in terms of sedation and anxiety reduction, with no significant difference between the two drugs in these outcomes.

Evaluation of the effects of pregabalin and dexamethasone coadministration on preemptive multimodal analgesia and anxiety in third molar surgeries: a triple-blind randomized clinical trial

OBJECTIVE

To evaluate the efficacy of pregabalin and dexamethasone coadministration in preemptive analgesia and anxiety control in lower third molar surgery.

MATERIALS AND METHODS

A triple-blind, split-mouth clinical trial conducted with patients divided into two groups: control group, receiving placebo and dexamethasone, and test group, receiving pregabalin and dexamethasone preoperatively. The evaluated variables were pain, measured by the Visual Analog Scale (VAS), anxiety assessed through the State-Trait Anxiety Inventory (STAI) questionnaires, hemodynamic parameters [Blood Pressure (BP), Heart Rate (HR), Oxygen Saturation (SpO2)], and sedation assessed by the Ramsay scale.

RESULTS

A total of 31 patients were included. The test group exhibited a significant reduction in pain at 2,4,6,8,12,16,24, and 48 h after surgery and in the consumption of rescue analgesics. Anxiety, evaluated by STAI and VAS, showed a significant decrease in the test group (p < 0.001). Additionally, there was a significant decrease in BP at most of the assessed time points (p < 0.05) and a significant reduction in HR at two different time intervals (p = 0.003 and p = 0.009), indicating a positive effect in the test group. There was no significant difference in SpO2 between the groups. Sedation assessment revealed a significant difference at all time points favoring the test group (p < 0.05). There were no significant postoperative adverse effects.

CONCLUSIONS

Pregabalin coadministered with dexamethasone demonstrated significant efficacy in controlling postoperative pain and anxiety, as well as a sedative effect.

CLINICAL RELEVANCE

The coadministration of pregabalin with dexamethasone may presents potential advantages in both pain modulation and psychological well-being of individuals undergoing third molar surgeries.

TRIAL REGISTRATION

Brazilian Clinical Trials Registry (REBEC), No. RBR-378h6t6.

The anxiolytic effects of preoperative administration of pregabalin in comparison to diazepam and placebo

We aimed to evaluate the potential anxiolytic effects of premedication with pregabalin, compared with diazepam and placebo. We conducted this non-inferiority, double-blind, randomized controlled trial in ASA classification I-II patients aged 18-70 years, scheduled for elective surgery under general anesthesia. They were allocated to receive pregabalin (75 mg the night before surgery and 150 mg 2 h before surgery), diazepam (5 and 10 mg in the same manner) or placebo. Preoperative anxiety was evaluated using verbal numerical rating scale (VNRS) and Amsterdam Preoperative Anxiety and Information Scale (APAIS) before and after premedication. Sleep quality, sedation level, and adverse effects were assessed as secondary outcomes. A total of 231 patients were screened and 224 completed the trial. The mean change (95%CI) in anxiety scores from before to after medication in pregabalin, diazepam, and placebo groups for VNRS were - 0.87 (- 1.43, - 0.30), - 1.17 (- 1.74, - 0.60), and - 0.99 (- 1.56, - 0.41), and for APAIS were - 0.38 (- 1.04, 0.28), - 0.83 (- 1.49, - 0.16), and - 0.27 (- 0.95, 0.40). The difference in change for pregabalin versus diazepam was 0.30 (- 0.50, 1.11) for VNRS and 0.45 (- 0.49, 1.38) for APAIS, exceeding the limit of inferiority for APAIS of 1.3. Sleep quality was statistically different between pregabalin and placebo groups (p = 0.048). Sedation in pregabalin and diazepam groups were significantly higher than placebo group (p = 0.008). No significant differences of other side effects, except dry mouth was higher in placebo group compared with diazepam (p = 0.006). The study filed to provide evidence at non-inferiority of pregabalin compared to diazepam. Furthermore, premedication with either pregabalin or diazepam did not significantly reduce the preoperative anxiety in comparison to placebo, despite the fact that both resulted in higher levels of sedation. Clinicians should weigh the benefits and risks of premedication with these 2 drugs.Thai Clinical Trials Registry: TCTR20190424001 (24/04/2019) Registry URL: https://www.thaiclinicaltrials.org/ .

Pregabalin Alleviates Anxiety and Fear in Cats during Transportation and Veterinary Visits-A Clinical Field Study

Cats frequently suffer from anxiety related to travel and veterinary visits. One sequela is avoidance of veterinary visits and lack of adequate veterinary care. The objective of this study was to test clinical efficacy and safety of a novel formulation of a pregabalin 50 mg/mL oral solution for alleviation of anxiety and fear in cats during transport and veterinary visits. A total of 209 client-owned cats were given either a flavored pregabalin oral solution at the dosage of 5 mg/kg (n = 108) or an identical placebo (n = 101) approximately 90 min before placing them into the carrier and transporting them in a car for at least 20 min to a veterinary clinic. The treatment effect using a 5-point numerical rating scale was evaluated during transportation by the owner and during clinical examination by the veterinarian, both blinded to the treatment. In addition, to verify the owner assessment, an external expert blinded to the treatment and owner assessment evaluated the transportation video recordings using the same rating scale as the owner. Pregabalin 5 mg/kg statistically significantly decreased both travel- (p < 0.01) and veterinary-visit- (p < 0.01) related anxiety compared to the placebo. The external expert's evaluation was in agreement with the owners' assessment confirming the treatment effect during transportation (p < 0.01). Treatment was well tolerated with only a few cats showing transient slight incoordination and tiredness. The flavored oral solution formulation with a small dosing volume of 0.1 mL/kg was found by the owners to be user-friendly and was well-accepted by the cats. This study demonstrated that a single oral dosage of the novel pregabalin oral solution alleviates anxiety and fear related to transportation and veterinary visits in cats, thus providing practical aid for both owners and veterinarians to enable cat-friendly handling and improving the welfare of cats in situations they often perceive as very stressful.

Gabapentin and pregabalin in bipolar disorder, anxiety states, and insomnia: Systematic review, meta-analysis, and rationale

The gabapentinoids, gabapentin, and pregabalin, target the α₂δ subunits of voltage-gated calcium channels. Initially licensed for pain and seizures, they have become widely prescribed drugs. Many of these uses are off-label for psychiatric indications, and there is increasing concern about their safety, so it is particularly important to have good evidence to justify this usage. We conducted a systematic review and meta-analysis of the evidence for three of their common psychiatric uses: bipolar disorder, anxiety, and insomnia. Fifty-five double-blind randomised controlled trials (RCTs) and 15 open-label studies were identified. For bipolar disorder, four double-blind RCTs investigating gabapentin, and no double-blind RCTs investigating pregabalin, were identified. A quantitative synthesis could not be performed due to heterogeneity in the study population, design and outcome measures. Across the anxiety spectrum, a consistent but not universal effect in favour of gabapentinoids compared to placebo was seen (standardised mean difference [SMD] ranging between -2.25 and -0.25). Notably, pregabalin (SMD -0.55, 95% CI -0.92 to -0.18) and gabapentin (SMD -0.92, 95% CI -1.32 to -0.52) were more effective than placebo in reducing preoperative anxiety. In insomnia, results were inconclusive. We conclude that there is moderate evidence of the efficacy of gabapentinoids in anxiety states, but minimal evidence in bipolar disorder and insomnia and they should be used for these disorders only with strong justification. This recommendation applies despite the attractive pharmacological and genetic rationale for targeting voltage-gated calcium channels.

A bibliometric analysis of preoperative anxiety research (2001-2021)

Recently, mental health has received increasing attention, particularly preoperative anxiety, which constitutes a bad emotional experience for surgical patients. Many experts have studied preoperative anxiety in terms of its related risk factors, interventions, and postoperative effects; however, there has been no systematic analysis of published articles. This paper presents a bibliometric review of documents related to preoperative anxiety published between 2001 and 2021. A detailed data analysis of 1,596 publications was conducted using CiteSpace and VOSviewer. Since the 20th century, the field of preoperative anxiety has gradually developed; research began around 2000 and has made a huge leap forward since 2016. Developed countries, led by the United States, were the first to conduct research, but preoperative anxiety research in developing countries like Turkey and China has gradually increased and led to an irreplaceable contribution. Intervention has remained the main topic of preoperative anxiety research, and measures have developed from premedication to the provision of education and information. Moreover, the use of advanced equipment such as virtual reality has emerged with great popularity. Based on previous research, the application of virtual reality combined with pediatric patients will become a new research direction.

The effect of pregabalin on postdural puncture headache among patients undergoing elective cesarean section: A randomized controlled trial

INTRODUCTION

Post-dural puncture headache (PDPH) is one of the most common problems of cesarean section. The present study aimed to evaluate the effect of pregabalin on PDPH among patients undergoing elective cesarean section.

MATERIALS AND METHODS

This double-blind clinical trial was performed on 136 patients undergoing elective cesarean section referred to Shahid Motahari Teaching Hospital in Urmia in northwestern Iran from February 1 to December 20, 2020. Patients were selected by convenience sampling method and randomly divided into two groups of intervention and control (N = 68 people each group). The presence of PDPH and its severity were recorded in the checklist based on the VAS, and conventional treatments were prescribed in the case of occurrence of the PDPH. The PDPH severity was also assessed by the patient using the 10-cm Visual Analog Scale (VAS).

RESULTS

The mean age of participants was 27.82 years. A total of 29 people suffered from hypotension. Regarding pain severity, the mean pain score in the intervention group was significantly lower than the control group (p = 0.01). Results also showed that the frequency of PDPH in the intervention group was significantly lower than the placebo group (4.4% vs. 11.8%; p = 0.019). There was no significant difference between intervention and control groups in terms of demographic characteristics (p > 0.05).

CONCLUSION

Results of the present study showed the use of oral pregabalin at night before spinal anesthesia in patients undergoing elective cesarean(C-) section had a preventive effect on the severity and incidence of PDPH.

Is there any difference between oral preemptive pregabalin vs. placebo administration on response to EBUS-TBNA under sedation?

Background/aim

The aim of this study is to evaluate the effects of preemptive oral pregabalin on hemodynamic response, anxiety, sedation, and recovery in patients who underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) under sedation with intravenous ketamine-propofol combination.

Materials and methods

Sixty patients were included in this study, and patients were randomly divided into two equal groups to receive the placebo (Group 1) versus pregabalin 150 mg (Group 2) one hour prior to EBUS- TBNA procedure. Patients received 0.25 mg kg^-1 ketamine and 0.25 mg kg^-1 propofol mixture (ketofol) for sedation. Timing of the parameters was defined as follows; T0: in hospital ward before pregabalin or placebo administration, T1: premedication, T2: in operating room, T3: before the procedure, T4: initiation, T5: 3 min after induction, T6: 6 min after induction, T7: 9 min after induction, and T8: 12 min after induction. Hemodynamic parameters, severity of coughing, sedation and anxiety scores, and complications were recorded. The level of satisfaction of the bronchoscopist and the patients were evaluated at the end of the procedure.

Results

The heart rate and mean arterial pressure were significantly higher in Group 1 (P = 0.008, P = 0.04). Total doses of anesthetics, recovery time, and desaturation rate were significantly higher in Group 1 (P = 0.014, P = 0.001, P = 0.045). In Group 2, SpO₂ level was significantly higher at various time periods (T1; P = 0.025, T4; P =0.043, T6; P = 0.001, T7; P = 0.003, T8; P < 0.001). The severity of coughing was found significantly lower in Group 2 (T4; P = 0.011, T5; P = 0.01, T6; P = 0.02, T7; P = 0.03, T8; P < 0.01). Anxiety scores were significantly lower in Group 2 (P < 0.001).

Conclusion

Preemptive oral pregabalin, in addition to sedation with ketamine-propofol combination, was effective in providing limited hemodynamic response, restricted coughing reflex, and lower anxiety during EBUS-TBNA. Besides, with pregabalin usage, decreased anesthetics consumption, lower complication rate, and shorter recovery time might have contributed to safety of the procedure and comfort of the bronchoscopist.