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A Single Preoperative Administration of Dexamethasone, Low-dose Pregabalin, or a Combination of the 2, in Spinal Surgery, Does Not Provide a Better Analgesia Than a Multimodal Analgesic Protocol Alone

Momon, Aurélien, MB*; Verdier, Bruno, MB*; Dolomie, Jacques-Olivier, MB*; Gardette, Mélanie, MB*; Pereira, Bruno, PhD; Curt, Isabelle, MB*; Dualé, Christian, MD, PhD‡,§

The Clinical Journal of Pain: July 2019 - Volume 35 - Issue 7 - p 594–601
doi: 10.1097/AJP.0000000000000719
Original Articles
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Objectives: A single perioperative dose of glucocorticoid or gabapentinoid, or a combination of the 2, may improve postoperative analgesia, but data are still insufficient to be conclusive. In this single-center, randomized, double-blind, and double-dummy trial, we aimed to test whether the analgesic effect of adding preoperative pregabalin, at a dose unlikely to induce side effects, to preoperative dexamethasone improves early mobilization after spinal surgery.

Materials and Methods: A total of 160 patients undergoing scheduled lumbar disk surgery (145 analyzed) comprised the study cohort. The patients received either 0.2 mg/kg intravenous dexamethasone before incision, or 150 mg oral pregabalin 1 hour before surgery, or a combination of the 2, or none of the above (control). Analgesia was supplemented by acetaminophen and ketoprofen, plus oxycodone ad libitum. The primary outcome was pain intensity during the first attempt to sit up, assessed the morning of the first postoperative day on an 11-point Numerical Rating Scale. Pain at rest and when standing up, opioid consumption, and tolerance were also assessed.

Results: None of the treatments tested differed from the control group in terms of efficacy or tolerance, even 6 months after surgery. The overall quality of analgesia was good, with only 10% and 30% of pain scores exceeding 3/10 for pain at rest and during movement, respectively.

Discussion: In this surgical model with the given anesthetic and analgesic environment, there was no advantage gained by adding low-dose pregabalin or dexamethasone. The multimodal analgesic protocol applied to all patients may have reduced the size of the effect.

*Perioperative Medicine

Department of Clinical Research and Innovation, CHU (University Hospital)

CHU (University Hospital) Clermont-Ferrand, Centre of Clinical Pharmacology (INSERM CIC1405)

§INSERM UMR1107, Clermont-Ferrand, France

The authors declare no conflict of interest.

Reprints: Christian Dualé, MD, PhD, Centre of Clinical Pharmacology (INSERM CIC1405), CHU Clermont-Ferrand; 58 rue Montalembert, BP 69, 63003 Clermont-Ferrand Cedex 1, France (e-mail: cduale@chu-clermontferrand.fr).

Received November 13, 2018

Received in revised form February 8, 2019

Accepted April 9, 2019

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