Pregabalin reduced persistent pain after cardiac surgery

The incidence of chronic pain after cardiac surgery was reduced in patients who received pregabalin before and after surgery, according to study data presented at the American Society of Anesthesiologists’ annual meeting.

The randomized controlled, double blind study included 150 patients who were scheduled for elective cardiac surgery. The patients were divided into three groups: pregabalin preoperatively and twice daily for 14 days after surgery; preoperative and postoperative pregabalin plus low-dose ketamine infusion for 48 hours after surgery; or a placebo-based regimen. All other surgical and anesthetic care was unchanged and included patient-controlled morphine after surgery, according to a press release.

Use of pregabalin reduced the incidence of persistent postsurgical pain in 10% and 8% of patients at 3 and 6 months, respectively. The incidence of pain in the placebo group was 50% at 3 months and 46% at 6 months. The addition of ketamine to the pregabalin regimen did not significantly affect pain after surgery, according to results presented.

Researchers also found that pain sensitivity tests conducted at the time of surgery could predict patients at risk for developing long-term postoperative persistent pain. Quantitative sensory testing of the patients’ nervous system was performed before and after surgery. One technique involved inducing pain by applying measured pressure at four points on the chest, followed by a second distracting pain in the arm with use of a tight BP cuff. Measurement of a patient’s change in pain sensitivity before and after the distracting arm pain, as well as before and after surgery, predicted whether the patient would develop postoperative persistent pain, according to the release.

In addition, “a patient’s anxiety and worry about the procedure in the days leading up to the surgery had a direct and independent effect on his or her acute and persistent postsurgical pain,” Sibtain Anwar, MB, MA, FRCA, research fellow at Barts and the London School of Medicine and Dentistry, said in a press release. “Positive thoughts and attitude about pain in general improved long-term pain outcomes.”

“This study reveals the potential benefit of preventive analgesia in patients experiencing moderate to severe surgical pain and links this with both peripheral and central nervous system changes during this period,” Anwar and colleagues concluded in the study abstract.

For more information:

Anwar S. Abstract A2164. Presented at: Anesthesiology 2013; Oct. 12-16, 2013; San Francisco.

Disclosure: Cardiology Today could not confirm the researchers’ relevant financial disclosures.