Impact of Pregabalin in Chronic Users vs. a Perioperative Limited Prescription on Oxycodone Requirement
- Conditions
- Neuropathic PainPostoperative Pain
- Interventions
- Other: Naive patient
- Registration Number
- NCT02866396
- Lead Sponsor
- Christophe Aveline, MD
- Brief Summary
Spinal surgery is associated with intense pain and associated to a history of preoperative chronic pain. Pregabalin is licensed to treat chronic neuropathic pain, particularly when high dose of opioid are required. Preoperative pain is associated with high postoperative pain scores and opioid requirement promoting persistent hyperalgesic state. The investigators will evaluate the postoperative opioid consumption and pain scores in patients scheduled for lumbar surgery and taking pregabalin since more than 15 days and compare with preoperative pregabalin-free patient that will receive pregabalin only during surgery.
- Detailed Description
Patients will be prospectively included and compared according their preoperative medication: pregabalin-treated patients (\>more than 15 days) for neuropathic pain associated to spinal surgery and pregabalin-free patients for whom pregabalin will be prescribed for 48 hours. Patients will be included without randomization as an observational study. All the patients will receive multimodal analgesia and intraoperative management will be standardized. The main outcome will be the amount of oxycodone during the first 24h after surgery. Other outcomes include pain scores, the quantification of the neuropathic pain diagnostic questionnaire (DN4), nausea and vomiting, length of stay, side-effects of pregabalin and opioid. Patients were also evaluated at three months for pain scores and DN4 score. Postoperative evaluation will be performed in a single-blind manner with investigators not include in the recruitment or the peroperative period.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 70
- American Society Anesthesiologist Physical status (ASA) 1-3
- Age ≥18 years old
- Spinal surgery: discectomy, posterior or transforaminal lumbar interbody fusion limited to 2 levels, lumbar disk prosthesis
- Able to participate personality, has given free and inform consent in French
- Affiliated of beneficiary of a system of social security
- Age less than 18 years or higher than 85 years old
- Refusal to participate or provide written consent
- Surgery with a combined anterior and posterior approach
- Emergency surgery, reintervention, spine fracture, metastasis
- Tricyclic antidepressant use
- Pregabalin use for other indication: other neuropathy, epilepsy, generalized anxiety disorder
- Pregnancy
- Lack of understanding of NRS and/or DN4 scores
- Hypersensibility or contraindication to levobupivacaine, paracetamol, nefopam, ketoprofen and/or oxycodone
- Participation in another clinical study
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Arm && Interventions
Group Intervention Description Naive patients Naive patient Pregabalin 150mg PO initiated 1h before surgery and associated to paracetamol 1g PO and ketoprofen 100mg PO Intraoperative: nefopam 20mg IV + ketamine 0.3mg/kg IV + dexamethasone 8mg IV Postoperative: morphine titration in PACU (NRS \> 3) + paracetamol 1g/6h PO + ketoprofen 100mg/12h PO systematically, oxycodone 5-10mg/12h PO if NRS\>3 Pregabalin patients Pregabalin Same dose of preoperative pregabalin 1h after surgery associated to paracetamol 1g PO and ketoprofen 100mg PO Intraoperative: nefopam 20mg IV + ketamine 0.3mg/kg IV + dexamethasone 8mg IV Postoperative: morphine titration (PACU if NRS \> 3) + paracetamol 1g/6h PO + ketoprofen 100mg/12h PO systematically, oxycodone 5-10mg/12h PO if NRS\>3
- Primary Outcome Measures
Name Time Method Oxycodone consumption 24h postoperatively mg
- Secondary Outcome Measures
Name Time Method Numeric Rating Scale Pain (NRS) during walking 3 months ater surgery NRS: 0 no pain - 10 worst pain
remifentanil consumption during surgery µg/kg/min
Oxycodone requirement 0-48h after surgery mg
Morphine titration 0-2h after surgery mg
Ondansetron requirement 0-48h after surgery mg
DN4 score three months after surgery length of stay on postoperative day five days
Post Opertive Nausea and vomiting (PONV) 0-48h after surgery % of patients
Numeric Rating Scale (NRS) Pain at rest the day before surgery NRS: 0 no pain - 10 worst pain
Numeric Rating Scale (NRS) Pain during walking the day before surgery NRS: 0 no pain - 10 worst pain
Numeric Rating Scale Pain (NRS) at rest 3 months after surgery NRS: 0 no pain - 10 worst pain
Pregabalin side-effects 0-48h after surgery diplopia, confusion, dizziness, psychiatric disorders (% of patients)
Sedation 0-48h after surgery 1: awake - 2: drowsiness, easily awake by appeal - 3: drowsiness, awake to tactile stimulation - 4: drowsiness, awake by pain
Trial Locations
- Locations (1)
Christophe Aveline, MD
🇫🇷Cesson Sevigne, France
Christophe Aveline, MD🇫🇷Cesson Sevigne, France