Perioperative Pregabalin Reduces Neuropathic Pain at 6 Months after Total Knee Arthroplasty (TKA) Asokumar Buvanendran, MD, Scott S. Reuben, MD, Jeffrey S. Kroin, PhD., Mario Moric, PhD, Kenneth J. Tuman, MD Anesthesiology, Rush Medical College, Chicago, Illinois Introduction: Pregabalin has been shown to be effective for the treatment of chronic neuropathic pain (Pain Res Manag 2006; 11:16A; Curr Opin Anaesthesiol 2007; 20:456). This study was designed to evaluate if pregabalin given prior to and for 14 days after total knee arthroplasty (TKA) will reduce the prevalence of neuropathic pain at 3 and 6 months after surgery. Methods: Following IRB approval, a total of 300 patients having primary TKA were enrolled in this randomized, placebo-controlled, double-blind study. Patients were randomly assigned to 2 drug groups. Two hours prior to surgery, half of the patients received pregabalin 300 mg orally, and the other half received matching placebo. In the operating room, patients were sedated with midazolam and a combined spinal-epidural procedure performed. At completion of surgery, epidural infusion of fentanyl/bupivacaine was initiated using continuous basal infusion with superimposed patient-controlled bolus. Patients subsequently received repeated doses of pregabalin 150 mg b.i.d. or placebo starting the day after surgery, with drug dosing continued until day 14 post-surgery. The incidence of neuropathic pain was assessed by a blinded investigator at 3 and 6 months post-surgery using the S-LANSS score, a valid diagnostic tool to assess neuropathic pain, with patients scoring ≥12 considered to have neuropathic pain (J Pain 2005; 6:149). The incidence of mechanical allodynia (stroking) or hyperalgesia (pressure) was also recorded. Comparison between the 2 groups was by chi-squared test. Results: There was no difference in demographics (age, weight, etc.) between the 2 groups. At 3 months post-TKA, the incidence of patients with neuropathic pain post-TKA was lower in the pregabalin (1.8%) group compared to the placebo (14.2%) (P=0.0006) (fig). The incidence of allodynia in the operated leg was also lower (P=0.020) at 3 months for the pregabalin group (16.4%) than the placebo group (29.1%); the incidence of hyperalgesia in the operated leg was lower (P=0.005) at 3 months for the pregabalin group (16.4%) than the placebo group (32.3%). At 6 months post-TKA, the incidence of patients with neuropathic pain post-TKA was lower in the pregabalin (0.9%) group compared to the placebo (9.4%) (P=0.004) (fig). The incidence of allodynia in the operated leg was also lower (P=0.004) at 6 months for the pregabalin group (6.4%) than the placebo group (19.5%); the incidence of hyperalgesia in the operated leg was lower (P=0.001) at 6 months for the pregabalin group (6.4%) than the placebo group (21.1%). Discussion: Perioperative administration of pregabalin decreased the incidence of neuropathic pain at 3 and 6 months after TKA. This suggests that pregabalin may be a useful perioperative medication for decreasing the incidence of chronic pain for patients undergoing this surgical procedure. [figure1]
Medical Aesthetic History Form (Please Print) Patient Name: _______________________ _______________ ___ Date of Birth: __________ Age: ______ M __ F__ Please circle your answers to the questions below. Your answers will assist us in providing you with the best care possible. Do you have an active infection, fever, flu, cold sores or cold symptoms? Yes No Have you used medications or h
All men hate the wretched; how, then, must I be hated, whom am miserable beyond all living things! —– The Creature There’s a scene in the movie Splash when the mermaid, played like a fish out of water by Darryl Hannah, wanders into Bloomingdale’s. Unsure about her new surroundings, the winsome blonde parks herself in front of a wall of television sets. A man’s face on 20 screens is
