Perioperative pregabalin improves postoperative outcomes after tka l.jpg
Sponsored Links
This presentation is the property of its rightful owner.
1 / 13

Perioperative Pregabalin Improves Postoperative Outcomes after TKA PowerPoint PPT Presentation


  • 204 Views
  • Uploaded on
  • Presentation posted in: General

Perioperative Pregabalin Improves Postoperative Outcomes after TKA. Asokumar Buvanendran, MD Associate Professor Director of Orthopedic Anesthesia Department of Anesthesiology Rush University Medical College Chicago, IL. Co-Investigators: J. Kroin, PhD

Download Presentation

Perioperative Pregabalin Improves Postoperative Outcomes after TKA

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Perioperative Pregabalin Improves Postoperative Outcomes after TKA

Asokumar Buvanendran, MD

Associate Professor

Director of Orthopedic Anesthesia

Department of Anesthesiology

Rush University Medical College

Chicago, IL


Co-Investigators:

J. Kroin, PhD

C. Dellavalle, MD (orthopedic surgery)

M. Kari, MD

M. Moric, PhD

K. Tuman, MD

Medical school grant from Pfizer


Mechanism of Analgesia

  • Gabapentin and Pregabalin bind to the alpha-2-delta sub-unit of the N-type voltage gated calcium channel

    • Same mechanism of action whether it is neuropathic pain or inflammatory pain (post-surgical)

  • This binding results in ↓ release of

    • Substance P, Calcitonin Gene-related peptide

    • Glutamate

  • Little effect on normal neuronal tissue, but only effective in sensitized neuronal tissue


Pregabalin and Postoperative Pain

  • 3-5 RCT all show:

    • ↓ pain scores

    • Opioid sparing

  • Doses used preop:100-300 mg

  • Doses used postop: 75-150 mg

Gilron I: Current opinion Anesthesiology 2007; 20: 456-472


RCT: Study Design (Level 1)

  • 240 Patients randomized into 2 groups:

    • Preop pregabalin 300 mg + Postop 150 mg BID for 10 days and then 75 mg BID and titrated to 50 mg and stopped on day #14

    • Preop Placebo + Postop Placebo

  • Standard surgery and anesthesia

  • Anesthesia:

    • Combined spinal epidural


RCT: Study Design (Level 1)

  • Outcomes:

    • Standard postoperative epidural solution of fentanyl + Bupivacaine:

      • consumption titrated to VAS Acute Pain

    • VAS Scores

    • Sleep Interference

    • ROM of the operated Knee:

      • Active

      • Passive


Demographics


Results: Epidural Consumption

Epidural analgesic consumption over 24 hours was less in the pregabalin group versus placebo (P < 0.0001).


Results: ROM

Active ROM (P<0.001) was greater in the pregabalin group versus placebo.


Outcomes

  • Passive ROM: Postop Day #2:

    • Pregabalin:88.9  9.9

    • Placebo:83.7  15.2 * P =0.012

  • Sleep Interferance: Postop Day #1:

    • Pregabalin:2.9  3.3

    • Placebo:4.6  3.2 * P= 0.035


Incidence of Postoperative Adverse Events


Conclusion

  • The perioperative administration of Pregabalin for TKA patients can lead to:

    • ↓ Opioid consumption

    • ↑ ROM of the operated Knee both passive and active


  • Login