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Reduced Cost and Time to Discharge following TKA with Perioperative Pregabalin. 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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reduced cost and time to discharge following tka with perioperative pregabalin

Reduced Cost and Time to Discharge following TKA with Perioperative Pregabalin

Asokumar Buvanendran, MD

Associate Professor

Director of Orthopedic Anesthesia

Department of Anesthesiology

Rush University Medical College

Chicago, IL

slide2

Co-Investigators:

J. Kroin, PhD

C. Dellavalle, MD (orthopedic surgery)

M. Kari, MD

M. Moric, PhD

K. Tuman, MD

Medical school grant from Pfizer

slide3

Projections of Total Knee Replacements in US

Annual hospital charges for TKA (excluding physician fee) are projected to increase from $7.4 billion in 2005 to $40.8 billion in 2015.

slide4

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
  • It is indicated for Neuropathic pain and recently for fibromyalgia
slide5

RCT: Study Design (Level 1)

  • 100 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
  • Outcomes:
    • Time to achieve Discharge criteria
    • Cost of stay in the hospital
discharge time from the hospital
Discharge Time from the Hospital

Discharge Criteria used:

Physical therapist appraisal of minimal assistance needed for ambulation;

Hemodynamically stable;

Stable cardiac rhythm;

Noninfected incisions and afebrile patient;

Ability to void, bowel movements

slide9

Cost Savings

  • Total cost savings for study group:
    • $ 468.00 per patient
  • Annually 2,500 TKA done at Rush University
  • Total cost savings : $ 1.175 million
  • With 400,000 TKA in the US
    • Cost savings could be: 170 million/year
conclusion
Conclusion
  • The perioperative administration of Pregabalin for TKA patients can lead to:
    • ↓ Hospital length of stay
    • Lead to cost savings