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da Silva FG, Podestá MHMC, Silva TC, de Barros CM, de Carvalho BFV, Dos Reis TM, Espósito MC, Marrafon DAFDO, Nogueira DA, Diwan S, Ceron CS, Torres LH. Oral pregabalin is effective as preemptive analgesia in abdominal hysterectomy-A randomized controlled trial. Clin Exp Pharmacol Physiol 2023; 50:256-263. [PMID: 36440985 DOI: 10.1111/1440-1681.13742] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022]
Abstract
Postoperative pain is one of the main negative symptoms resulting from surgery and the use of new methods to control this symptom is of ever-increasing relevance. Opioid-sparing strategies, such as multimodal analgesia, are trends in this scenario. Pregabalin is a well-established treatment for neuropathic pain; however, it is still controversial in the surgical context for postoperative analgesia. This study investigated the effect of pregabalin on postoperative analgesia in patients undergoing abdominal hysterectomy. It is a prospective, randomised, double-blind, placebo-controlled clinical trial. Female patients undergoing abdominal hysterectomy were randomised to use pregabalin (group P1), 300 mg orally 2 h before surgery, or identical placebo pills (group P0). The main outcome includes the postoperative pain index by visual analogue scale (VAS) and McGill's pain questionnaire. Secondary outcomes include opioid consumption and the presence of adverse effects. A value of p < 0.05 was used to reject type I error. Fifty-five patients were randomised amongst the groups. Patients in group P1 had lower pain rates by VAS scale, both at rest and in active motion, than group P0. In McGill's questionnaire, patients from group P1 also had lower pain rates (12 × 28.5). There was approximately twice as much opioid consumption amongst patients in group P0. Regarding side effects, there was a difference between the two groups only for dizziness, being more incident in group P1. This study suggests that pregabalin is an important adjuvant drug in treating postoperative pain in patients with abdominal hysterectomy.
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Affiliation(s)
- Fabrício Gomes da Silva
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, Brazil.,Department of Anesthesiology, pain and palliative care, Santa Casa of Alfenas, Alfenas, Brazil
| | | | - Thayná Coelho Silva
- Department of Anesthesiology, pain and palliative care, Santa Casa of Alfenas, Alfenas, Brazil
| | - Carlos Marcelo de Barros
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, Brazil.,Department of Anesthesiology, pain and palliative care, Santa Casa of Alfenas, Alfenas, Brazil
| | | | - Tiago Marques Dos Reis
- Department of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, Brazil
| | - Milena Carla Espósito
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, Brazil
| | | | - Denismar Alves Nogueira
- Department of Statistics, Institute of Exact Sciences, Federal University of Alfenas, Alfenas, Brazil
| | - Sudhir Diwan
- Department of Anesthesiology and Pain Medicine, Lenox Hill Hospital, New York, USA
| | - Carla Speroni Ceron
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, Brazil
| | - Larissa Helena Torres
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, Brazil
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Assessing of analgesic efficacy of preemptive local anesthesia following vaginal hysterectomy. Eur J Obstet Gynecol Reprod Biol 2022; 276:244-245. [DOI: 10.1016/j.ejogrb.2022.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/29/2022] [Indexed: 11/21/2022]
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Abu-Zaid A, Alomar O, AlNaim NF, Abualsaud FS, Jamjoom MZ, AlNaim LF, Almubarki AAMA, Baradwan S, Aboudi SAS, Idris FK, Fodaneel M, Al-Badawi IA, Salem H. Preemptive pregabalin for postoperative analgesia during minimally invasive hysterectomy: a systematic review and meta-analysis of randomized controlled trials. Obstet Gynecol Sci 2022; 65:133-144. [PMID: 35193327 PMCID: PMC8942753 DOI: 10.5468/ogs.21345] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/07/2022] [Accepted: 02/03/2022] [Indexed: 11/17/2022] Open
Abstract
We aimed to perform a systematic review and meta-analysis of all randomized placebo-controlled trials (RCTs) that examined the analgesic benefits of preemptive pregabalin among patients undergoing minimally invasive hysterectomy. Five major databases were systematically screened from inception until August 29, 2021 Relevant studies were evaluated for risk of bias. Endpoints were analyzed using the random-effects model and pooled as the mean difference or risk ratio with a 95% confidence interval. Four studies with seven treatment arms met the inclusion criteria. The total sample size was 304 patients: 193 and 111 patients were allocated to the pregabalin and placebo groups, respectively. Overall, the included studies revealed a low risk of bias. The summary results revealed that the mean postoperative pain scores at rest were significantly lower in the pregabalin group than in the control group at 0, 2, 4, 6, 12, and 24 hours. Moreover, the mean postoperative pain scores on movement/coughing were significantly lower in the pregabalin group than in the control group at 12 and 24 hours. The rate of patients who were opioid-free postoperatively was significantly higher in the pregabalin group than in the control group. There was no significant difference between the groups in terms of the mean postoperative time to first rescue analgesic and the rates of adverse events. Compared with placebo, preemptive pregabalin was largely safe, and was correlated with superior analgesic effects in terms of lower postoperative pain scores and higher opioid-sparing effects. Additional RCTs are needed to confirm these findings.
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Affiliation(s)
- Ahmed Abu-Zaid
- Department of Obstetrics and Gynecology, College of Medicine, Alfaisal University, Riyadh,
Saudi Arabia
- College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN,
USA
| | - Osama Alomar
- Department of Obstetrics and Gynecology, College of Medicine, Alfaisal University, Riyadh,
Saudi Arabia
- King Faisal Specialist Hospital and Research Center, Riyadh,
Saudi Arabia
| | - Nora F AlNaim
- King Faisal Specialist Hospital and Research Center, Riyadh,
Saudi Arabia
| | | | | | - Latifa F AlNaim
- King Faisal Specialist Hospital and Research Center, Riyadh,
Saudi Arabia
| | | | - Saeed Baradwan
- King Faisal Specialist Hospital and Research Center, Jeddah,
Saudi Arabia
| | | | | | - Meshael Fodaneel
- King Faisal Specialist Hospital and Research Center, Riyadh,
Saudi Arabia
| | - Ismail A Al-Badawi
- Department of Obstetrics and Gynecology, College of Medicine, Alfaisal University, Riyadh,
Saudi Arabia
- King Faisal Specialist Hospital and Research Center, Riyadh,
Saudi Arabia
| | - Hany Salem
- Department of Obstetrics and Gynecology, College of Medicine, Alfaisal University, Riyadh,
Saudi Arabia
- King Faisal Specialist Hospital and Research Center, Riyadh,
Saudi Arabia
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Analgesia for Gynecologic Oncologic Surgeries: A Narrative Review. Curr Pain Headache Rep 2022; 26:1-13. [PMID: 35118596 DOI: 10.1007/s11916-022-00998-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Gynecologic oncologic malignancies are amongst the most common cancers affecting women across the world. This narrative review focuses on the current state of evidence around optimal perioperative pain management of patients undergoing surgeries for gynecologic malignancies with a specific focus on cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). RECENT FINDINGS Recent improvements in postoperative pain management following all types of gynecologic procedures, including minimally invasive, open-abdominal, or CRS + HIPEC, have been implemented through enhanced recovery after surgery (ERAS) protocols. These protocols encompass the use of preemptive analgesia, neuraxial and regional techniques, local anesthetic infiltration, and multimodal analgesia. The severity of postoperative pain varies for minimally invasive cancer surgery to open debulking procedures. Therefore, an individualized perioperative analgesic plan is critical depending on the surgical approach. For CRS + HIPEC, neuraxial techniques such as thoracic epidurals and opioid sparing multimodal analgesics have shown efficacy in the perioperative period. However, future research is needed as many of these patients develop chronic pain with very limited research done in this realm.
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Abstract
Adjuvant analgesics (ie, gabapentin, tramadol, and ketamine) are commonly used in small animal practice. Most of these drugs are prescribed for outpatients, when pain is refractory to classic analgesics (ie, local anesthetics, opioids, and nonsteroidal antiinflammatory drugs [NSAIDs]), or when contraindications exist to the administration of other analgesics, including NSAIDs. This article reviews the mechanisms of action, clinical use, potential adverse effects, and current evidence of adjuvant analgesics in the treatment of acute pain in companion animals. These drugs should be considered as alternatives aimed at reducing or replacing opioids.
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