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Perioperative Pregabalin Improves Postoperative Outcomes after TKA PowerPoint PPT Presentation


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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

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Perioperative Pregabalin Improves Postoperative Outcomes after TKA

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Perioperative pregabalin improves postoperative outcomes after tka l.jpg

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


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Co-Investigators:

J. Kroin, PhD

C. Dellavalle, MD (orthopedic surgery)

M. Kari, MD

M. Moric, PhD

K. Tuman, MD

Medical school grant from Pfizer


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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


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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


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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


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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


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Demographics


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Results: Epidural Consumption

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


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Results: ROM

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


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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


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Incidence of Postoperative Adverse Events


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Conclusion

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

    • ↓ Opioid consumption

    • ↑ ROM of the operated Knee both passive and active


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