Perioperative Oral Pregabalin Reduces Chronic Pain After Total Knee Arthroplasty: A Prospective, Randomized, Controlled Trial
Perioperative Oral Pregabalin Reduces Chronic Pain After Total Knee Arthroplasty: A Prospective, Randomized, Controlled Trial
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DOI：
10.1213/ane.0b013e3181c4273a
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发表时间：
2010-01-01
影响因子：
5.7
通讯作者：
Tuman, Kenneth J.
中科院分区：
文献类型：
--
作者：
Buvanendran, Asokumar;Kroin, Jeffrey S.;Tuman, Kenneth J.
背景技术背景：尽管全膝关节置换术（TKA）取得了巨大的成功，但慢性神经性疼痛可在术后发展，一旦建立，既令人痛苦又难以治疗。我们假设，围手术期治疗普瑞巴林，慢性疼痛药物，将减少术后神经性pain.METHODS的发病率：我们进行了一项随机，安慰剂对照，双盲试验普瑞巴林（300毫克）前TKA和TKA（150-50毫克，每天两次）后14天。在术后3个月和6个月，使用利兹神经性症状和体征量表评估对患者进行神经性疼痛筛查。次要结果包括术后恢复和康复措施，包括膝关节活动范围、阿片类药物消耗、术后疼痛评分、睡眠障碍和出院时间以及术后全身并发症的发生。在随机分配至2个治疗组的240例患者中，（各120例），主要结局数据来自113例普瑞巴林患者和115例安慰剂患者。术后3个月和6个月，普瑞巴林组神经性疼痛的发生率（0%）低于安慰剂组（3个月和6个月分别为8.7%和5.2%; P = 0.001和P = 0.014）。接受普瑞巴林治疗的患者也消耗较少的硬膜外阿片类药物（P = 0.003），住院期间需要较少的口服阿片类止痛药（P = 0.005），并且在术后前30天内具有更大的主动屈曲（P = 0.013）。两组间实际记录的住院时间无差异，但安慰剂组患者达到出院标准的时间（69.0 ± 16.0 h（平均值± SD））长于普瑞巴林组患者（60.2 ± 15.8 h）（P = 0.001）。镇静（P = 0.005）和混乱（P = 0.013）更频繁的手术当天和术后第1天的患者接受pregabalin.CONCLUSION：围手术期pregabalin管理减少慢性神经性疼痛的发生率TKA后，阿片类药物的消耗量少，更好的运动范围在康复的第一个30天。然而，在测试的剂量中，它与术后早期镇静和意识模糊的风险较高相关。（Anesth Analg 2010;110：199-207）
BACKGROUND: Despite the enormous success of total knee arthroplasty (TKA), chronic neuropathic pain can develop postoperatively and is both distressing and difficult to treat once established. We hypothesized that perioperative treatment with pregabalin, a chronic pain medication, would reduce the incidence of postsurgical neuropathic pain.METHODS: We performed a randomized, placebo-controlled, double-blind trial of pregabalin (300 mg) administered before TKA and for 14 days after TKA (150-50 mg twice daily). Patients were screened for the presence of neuropathic pain at 3 and 6 mo postoperatively using the Leeds Assessment of Neuropathic Symptoms and Signs scale. Secondary outcomes included postsurgical recovery and rehabilitation measures, including knee range of motion, opioid consumption, postoperative pain scores, sleep disturbance, and time to discharge as well as the occurrence of postoperative systemic complications.RESULTS: Of the 240 patients randomly assigned to the 2 treatment groups (120 in each), data for the primary Outcome were obtained from 113 pregabalin patients and 115 placebo patients. At both 3 and 6 mo postoperatively, the incidence of neuropathic pain was less frequent in the pregabalin group (0%) compared with the placebo group (8.7% and 5.2% at 3 and 6 mo, respectively; P = 0.001 and P = 0.014). Patients receiving pregabalin also consumed less epidural opioids (P = 0.003), required less oral opioid pain medication while hospitalized (P = 0.005), and had greater active flexion over the first 30 postoperative days (P = 0.013). There were no differences in the actual recorded duration of hospitalization between the 2 groups, although time to achieve hospital discharge criteria was longer for placebo patients, 69.0 +/- 16.0 h (mean +/- SD), than that of pregabalin patients, 60.2 +/- 15.8 h (P = 0.001). Sedation (P = 0.005) and confusion (P = 0.013) were more frequent on the day of surgery and postoperative day 1 in patients receiving pregabalin.CONCLUSION: Perioperative pregabalin administration reduces the incidence of chronic neuropathic pain after TKA, with less opioid consumption and better range of motion during the first 30 days of rehabilitation. However, in the doses tested, it is associated with a higher risk of early postoperative sedation and confusion. (Anesth Analg 2010;110:199-207)