PERIOPERATIVE PREGABALIN FOR POSTOPERATIVE PAIN RELIEF AFTER THORACOTOMY

Background: Pregabalin is effective both at controlling postoperative pain and preventing chronic neuropathic pain. Local anaesthetic infiltration is a simple and inexpensive method to provide postoperative analgesia. In this study we tested the hypothesis that pregabalin administered perioperatively combined with continuous wound infusion will aid better the post-thoracotomy pain management compared to pregabalin monotherapy. Methods: Forty five patients received either placebo (PLCB), pregabalin (PRG) or pregabalin and continuous wound infusion (PRG + CWI) of local anaesthetics. Postoperative data collection included opioid consumption, VAS scores at rest and during cough. At 1 and 3 months from surgery patients were assessed with the DN4 questionnaire for neuropathic pain. Results: VAS scores were significantly lower in the PRG+CWI group (p < 0.05) at rest while during cough the placebo group had higher scores than both treatment groups (p < 0.001 or p < 0.05). Morphine consumption measured at 48 hr PO revealed a significant difference in total morphine; PLCB: 49 ± 11mg, PRG: 33 ± 10mg and PRG+CWI: 28 ± 11mg (p < 0.001 between placebo and the other two groups). The incidence of neuropathic pain was more frequent in the placebo group (1-month: PLCB: 10 pt, PRG: 0 pt and PRG+ CWI: 0 pt (p < 0.001), 3 months: PLCB: 10 pts, PRG: 0 pt and PRG+ CWI: 0 pt (p < 0.001)). Conclusions: Perioperative administration of pregabalin significantly reduces pain scores, opioid consumption and incidence of neuropathic pain in post-thoracotomy patients. The addition of continuous wound infiltration of local anaesthetics although improved immediate postoperative analgesia at rest did not affect differently the development of neuropathic pain.