Comparative study between effect of preoperative multimodal analgesia and pregabalin as unimodal analgesia in reduction of postoperative opioids consumption and postoperative pain in laparoscopic cholecystectomy

IF 2.5 Q2 MULTIDISCIPLINARY SCIENCES Beni-Suef University Journal of Basic and Applied Sciences Pub Date : 2024-11-04 DOI:10.1186/s43088-024-00562-1
Yassmin M. Kamal, Engy A. Wahsh, Hisham A. Abdelwahab, Walied A. ElBaz, Hazem A. Hussein, Hoda M. Rabea
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Abstract

Background

Laparoscopic cholecystectomy is a popular abdominal surgery and the most common problem for patients undergoing laparoscopic cholecystectomy is the postoperative pain, and associated side effects due to opioids use for pain management and multimodal analgesia is suggested to reduce postoperative pain and need for postoperative opioids. This controlled clinical trial compares the effects of multimodal analgesia and pregabalin as unimodal analgesia on postoperative pain management, postoperative opioids consumption, and reduction of opioids accompanied adverse effects in patients undergoing laparoscopic cholecystectomy where large multicenter studies evaluating specific analgesic combinations are lacking.

Method

This comparison randomized controlled trial between multimodal analgesia approach and pregabalin as unimodal analgesia included 95 laparoscopic cholecystectomy patients that were randomly allocated to three groups using a simple randomization method where multimodal and pregabalin groups included 30 patients in each and the drugs was administered orally one hour before the incision and control group included 35 patients that did not receive any preoperative analgesia. Multimodal analgesic therapy included acetaminophen 1 g, pregabalin 150 mg and celecoxib 400 mg while pregabalin group received pregabalin 150 mg only.

Results

Multimodal group showed a significantly lower need for total opioid analgesics mean ± SD (1.33 ± 1.918) as compared to the control group mean ± SD (3.31 ± 2.784) with p-value 0.014. Pregabalin and multimodal groups showed significantly lower postoperative visual analogue scale used for pain assessment mean ± SD (3.50 ± 2.543) and mean ± SD (3.70 ± 2.231), respectively, compared to the control group mean ± SD (5.89 ± 2.857) with p-value 0.001.

Conclusion

Multimodal analgesia reduced postoperative opioids consumption more than pregabalin alone when used preoperatively in laparoscopic cholecystectomy and consequently reduced opioids associated adverse effects, but they have the same efficacy in reducing postoperative pain, so pregabalin can be used alone preoperatively in patients with contraindications for using some analgesics included in multimodal analgesia protocol. The study was registered retrospectively in clinical trials; Trial registration ID: NCT05547659.

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术前多模式镇痛与普瑞巴林作为单模式镇痛对减少腹腔镜胆囊切除术术后阿片类药物用量和术后疼痛效果的比较研究
背景腹腔镜胆囊切除术是一种流行的腹部手术,接受腹腔镜胆囊切除术的患者最常见的问题是术后疼痛,以及因使用阿片类药物止痛而产生的相关副作用。这项临床对照试验比较了多模式镇痛和普瑞巴林作为单模式镇痛对腹腔镜胆囊切除术患者术后疼痛控制、术后阿片类药物消耗和减少阿片类药物伴随不良反应的影响,目前缺乏评估特定镇痛组合的大型多中心研究。方法这项多模式镇痛方法与普瑞巴林作为单模式镇痛的对比随机对照试验纳入了 95 名腹腔镜胆囊切除术患者,采用简单的随机方法将他们随机分配到三组,其中多模式组和普瑞巴林组各有 30 名患者,在切口前一小时口服给药,对照组有 35 名患者,术前不接受任何镇痛治疗。多模式镇痛疗法包括对乙酰氨基酚 1 克、普瑞巴林 150 毫克和塞来昔布 400 毫克,而普瑞巴林组仅接受普瑞巴林 150 毫克。结果多模式组的阿片类镇痛药总需求量(平均值±标准差)(1.33±1.918)显著低于对照组(平均值±标准差)(3.31±2.784),P 值为 0.014。普瑞巴林组和多模式组的术后疼痛评估视觉模拟量表平均值(± SD)(3.50 ± 2.543)和平均值(± SD)(3.70 ± 2.231)分别明显低于对照组的平均值(± SD)(5.89 ± 2.857),P 值为 0.001。结论腹腔镜胆囊切除术术前使用多模式镇痛比单独使用普瑞巴林更能减少术后阿片类药物的用量,从而减少阿片类药物相关的不良反应,但它们在减轻术后疼痛方面具有相同的疗效,因此对于有使用多模式镇痛方案中某些镇痛药禁忌症的患者,术前可单独使用普瑞巴林。该研究在临床试验中进行了回顾性登记;试验登记号为 NCT05547659:NCT05547659。
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期刊介绍: Beni-Suef University Journal of Basic and Applied Sciences (BJBAS) is a peer-reviewed, open-access journal. This journal welcomes submissions of original research, literature reviews, and editorials in its respected fields of fundamental science, applied science (with a particular focus on the fields of applied nanotechnology and biotechnology), medical sciences, pharmaceutical sciences, and engineering. The multidisciplinary aspects of the journal encourage global collaboration between researchers in multiple fields and provide cross-disciplinary dissemination of findings.
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