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Year : 2019  |  Volume : 6  |  Issue : 3  |  Page : 266-272

A comparative study of postoperative effects of two doses of preemptive pregabalin after tibial fracture fixation under spinal anesthesia

Department of Anaesthesia and Surgical Intensive Care, Faculty of Medicine, University of Alexandria, Alexandria, Egypt

Correspondence Address:
MD Ahmed M Abdou
Professor of Anaesthesia and Intensive Care, Faculty of Medicine, Alexandria Faculty of Medicine, El-Azareeta, Champollion St., Alexandria, 21131
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/roaic.roaic_24_17

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Background Orthopedic patients experience severe immediate postoperative pain, and they require more analgesia. Effective management of perioperative and postoperative pain after lower extremity orthopedic surgery represents an important component of early postoperative recovery. It is essential to facilitate rehabilitation and accelerate functional recovery, enabling patients to return to their normal activity more quickly. Moreover, treating patient’s preoperative anxiety improves postoperative pain. Pregabalin was found to be useful in decreasing postoperative pain and analgesic requirements as well as anxiolytic and sleep-modulating effects. Objective This study compares analgesic, anxiolytic, and sedative effects of pregabalin 75 and 150 mg versus placebo in patients undergoing surgery for fixation of traumatic tibial fractures under spinal anesthesia. Patients and methods This blind study contained 45 patients scheduled for fixation of tibial fractures under spinal anesthesia using a closed envelope technique. The patients were divided into three groups (15 patients each). Group P75 received 75 mg pregabalin capsule, group P150 received 150 mg pregabalin capsule, and group P0 received matching placebo capsule. In the preoperative holding area, patients were randomly divided into three groups. Then, an intravenous line was secured. Then, an hour before the surgery, all patients underwent assessment of level of anxiety using visual analog scale and assessment of degree of sedation using Ramsay Sedation Scale. Thereafter, the drug selected for the study was given with a sip of water by a staff nurse who was not involved in the study. Before anesthesia, anxiety and sedation were reassessed for the second time for all patients using visual analog scale for anxiety and Ramsay Sedation Scale, respectively. Spinal anesthesia was instituted at L3–L4 interspace, and a volume of 2.5–3.5 ml (according to the patient’s height and weight) of 0.5% heavy bupivacaine was injected over 30 s through a 25-G spinal needle. In the postoperative period, all patients received ketorolac 30 mg/kg, and they were observed for pain score and level of sedation for 24 h postoperatively. Results The use of pregabalin 150 mg preoperatively succeeded in significantly decreasing the postoperative pain and analgesic requirements and increasing the sedation score in comparison with 75 mg dose. Both doses succeeded in significantly decreasing the preoperative anxiety. Conclusion The use of pregabalin before surgery for fixation of traumatic tibial fractures could achieve good postoperative analgesia, preoperative anxiolysis, and perioperative sedation.

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