The effect of pregabalin and celecoxib on the analgesic requirements after laparoscopic cholecystectomy: a randomized controlled trial

• Published in: Journal of anesthesia Vol. 30; no. 1; pp. 64 - 71
• Main Authors: Gurunathan, Usha, Rapchuk, Ivan L., King, Gillian, Barnett, Adrian G., Fraser, John F.
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01-02-2016; Springer
• Subjects: Adult; Aged; Analgesics - administration & dosage; Analgesics, Opioid - administration & dosage; Analysis; Anesthesiology; Celecoxib - administration & dosage; Cholecystectomy; Cholecystectomy, Laparoscopic - adverse effects; Cholecystectomy, Laparoscopic - methods; Critical Care Medicine; Double-Blind Method; Elective Surgical Procedures - methods; Emergency Medicine; Female; Fentanyl - administration & dosage; Health aspects; Humans; Intensive; Male; Medicine; Medicine & Public Health; Middle Aged; Nonsteroidal anti-inflammatory agents; Original Article; Pain Medicine; Pain, Postoperative - drug therapy; Patient Satisfaction; Pregabalin; Pregabalin - administration & dosage; Prospective Studies; Australia; Postoperative pain; Pregabalin; Celecoxib; Laparoscopic cholecystectomy
• ISSN: 0913-8668; 1438-8359
• DOI: 10.1007/s00540-015-2078-9

Purpose
Early postoperative pain is a common complaint after elective laparoscopic cholecystectomy. The use of non-opioid medications as a part of multimodal analgesia has been increasingly advocated in the management of acute post-surgical pain. This randomized, double-blinded, placebo-controlled study evaluated the efficacy of pregabalin, celecoxib, and their combination in the management of acute postoperative pain in patients undergoing elective laparoscopic cholecystectomy.
Methods
One hundred ASA I/II patients scheduled to undergo elective laparoscopic cholecystectomy were assigned to receive two perioperative doses, 12 h apart, of either pregabalin alone, celecoxib alone, their combination, or a placebo. Standard anesthetic protocol was followed. The primary outcomes were postoperative pain at rest and with movement. Secondary outcomes were fentanyl requirements and side effects, which were assessed at 1, 2, 4, 8, 12, and 24 h following surgery. Patient satisfaction with pain relief was recorded at discharge. Differences in main outcomes were analyzed using an intention-to-treat approach.
Results
There was no statistically significant difference (
p
 > 0.05) between the four groups in terms of outcomes such as rest pain, movement pain, postoperative fentanyl requirements, or changes in anxiety scores. Patients who had only celecoxib had significantly higher satisfaction with pain management (
p
 = 0.013). Patients who had only pregabalin were at three-times-higher odds of having drowsiness (
p
 = 0.040) and four-times-higher odds of having lightheadedness (
p
 = 0.019) when compared with the placebo group.
Conclusions
Pregabalin, celecoxib alone, or in combination offers no analgesic superiority over standard opioid care in the treatment of postoperative pain following laparoscopic cholecystectomy.