Pregabalin effective in post operative management of pain and vomiting in hysterectomy

A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted by Wang et al. to ascertain the effect of preoperative administration of pregabalin in controlling acute pain after hysterectomy. It was found that preoperative use of pregabalin reduced postoperative pain, total morphine consumption, and morphine-related complications following hysterectomy.The results have been published in journal Medicine.

High-quality pain control after hysterectomy remains a major challenge. Appropriate pain control is a prerequisite to promoting early mobilization and functional recovery after hysterectomy. Although opioid and nonsteroidal anti-inflammatory medications are widely used for acute postoperative pain, some patients are bothered by drowsiness, nausea, and vomiting.

The researchers conducted a systematic computer-based search in the PubMed, EMBASE, Web of Science, Cochrane Library, and Google databases in April 2017 . RCTs comparing pregabalin with placebo in patients undergoing hysterectomy were retrieved. The primary endpoint was the visual analog scale (VAS) score with rest or mobilization at 2 h, 4 and 24 hours and cumulative morphine consumption at 2, 4, 24, and 48 hours. The secondary outcomes were complications of nausea, vomiting, sedation, and dizziness. After tests for publication bias and heterogeneity among studies were performed, the data were aggregated for random-effects models when necessary.

In all ten clinical studies with 1207 patients (pregabalin = 760, control = 447) were finally included in this meta-analysis. It was found that preoperative administration of pregabalin was associated with a significant reduction of VAS with rest or mobilization at 2, 4, and 24 hours after hysterectomy. Further, the preoperative administration of pregabalin was associated with a reduction in total morphine consumption at 2, 4, 24, and 48 hours after hysterectomy. The occurrence of morphine-related complications (nausea and vomiting) was also reduced in the pregabalin group. However, the preoperative administration of pregabalin was associated with an increase in the occurrence of dizziness. There was no significant difference in the occurrence of sedation.

The researchers concluded that preoperative use of pregabalin reduced postoperative pain, total morphine consumption, and morphine-related complications following hysterectomy. The doses of pregabalin were different, and large heterogeneity was the limitation of the current meta-analysis. Further studies should determine the optimal dose for controlling acute pain after hysterectomy.