Preoperative use of pregabalin for acute pain in spine surgery: A meta-analysis of randomized controlled trials

Abstract

Background: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of pregabalin for pain management following spine surgery.

Methods: In September 2016, a systematic computer-based search was conducted in PubMed, EMBASE, Web of Science, and Cochrane Database of Systematic Reviews. RCTs of patients prepared for spine surgery that compared pregabalin with placebo were retrieved. The primary endpoint was the VAS score with rest or mobilization at 12 hours, 24 hours, and 48 hours and cumulative morphine consumption at 24 hours and 48 hours. The secondary outcomes were complications of nausea, sedation, dizziness, headache, and visual disturbances. After testing for publication bias and heterogeneity between studies, data were aggregated for random-effects models when necessary.

Results: Ten clinical studies with 535 patients (pregabalin group = 294, control group = 241) were included in the meta-analysis. Pregabalin was associated with reduced pain scores at 12 hours, 24 hours, and 48 hours, corresponding to a reduction of 1.91 points (95% CI, -4.07 to 0.24 point) at 12 hours, 2.66 points (95% CI, -4.51 to -0.81 point) at 24 hours, and 4.33 points (95% confidence interval, -6.38 to -2.99 point) at 48 hours on a 100-point numeric rating scale. There was no significant difference between VAS scores with mobilization at 12 hours, 24 hours, or 48 hours. Similarly, pregabalin was associated with a reduction in cumulative morphine consumption at 24 hours (-7.07, 95% CI -9.84, -4.30) and 48 hours (-6.52, 95% CI -7.78, -5.25, P = 0.000). Furthermore, pregabalin can reduce the occurrence of nausea (RR 0.57, 95% CI 0.41, 0.79, P = 0.001, number needed to treat = 8.4). There were no significant differences in the occurrence of sedation, dizziness, headache, or visual disturbances.

Conclusions: Preoperative use of pregabalin was efficacious in reduction of postoperative pain, total morphine consumption, and the occurrence of nausea following spine surgery. Because the sample size and the number of included studies were limited, a multicenter RCT is needed to identify the effects and optimal dose of pregabalin for reducing acute pain after spine surgery.

Figure 1

PRISMA flowchart for the included studies. PRISMA = preferred reporting items for systematic reviews and meta-analyses.

Figure 2

The risk of bias graph for the included studies.

Figure 3

The risk of bias summary for the included studies.

Figure 4

Forest plot comparing VAS scores with rest at 12 h, 24 h, and 48 h. VAS = visual analog scale.

Figure 5

Funnel plot testing the publication bias of the VAS with rest at 12 h (A), 24 h (B), and 48 h (C) and Begg's test for VAS with rest at 12 h (D), 24 h (E), and 48 h (F). VAS = visual analog scale.

Figure 6

Forest plot comparing the VAS with mobilization at 12 h, 24 h, and 48 h. VAS = visual analog scale.

Figure 7

Forest plot of cumulative morphine consumption at 24 h and 48 h between the 2 groups.

Figure 8

Forest plots comparing the occurrence of sedation, B headache, C dizziness and D visual disturbances between the 2 groups.

Figure 9

Forest plot comparing the occurrence of nausea between the 2 groups.