Abstract:
Pain relief after surgical procedures continues to be a major medical challenge.
Alleviation of pain has been given a high priority by medical professionals and health
authorities. Improvement in perioperative analgesia is not only desirable for humanitarian
reasons but also essential for its potential to reduce postoperative morbidity
and mortality.1,2 Unsatisfactory analgesia increases discomfort of the patient and
prolongs hospital stay.3 This means an increase in the incidence of complications and
treatment costs.3 Moreover, it may lead to development of chronic pain as an adverse
effect, one of the most devastating problems related to this issue if acute pain cannot
be treated as required.4
Postoperative pain is not purely nociceptive in nature and may consist of inflammatory,
neurogenic, and visceral components.5 Sensitization of the dorsal horn
neurons has been demonstrated in acute pain models and may also play a role in the
development of chronic pain after surgery.6 By reducing the hyperexcitability of
dorsal horn neurons induced by tissue damage, gabapentin and pregabalin may have
roles in the treatment of postoperative pain.7,8
Pregabalin is the pharmacologically active S-enantiomer of 3-aminomethyl-5-
methyl-hexanoic acid.9 It is a structural analogue of -aminobutyric acid, one of
the key inhibitory neurotransmitters in the brain. Its mode of action is believed
to be mediated by the -2--1 subunit protein of voltage-gated calcium channels,
resulting in its anxiolytic, anticonvulsant, and antinociceptive effects.10
Pregabalin is rapidly absorbed with peak blood concentrations occurring within
1 hour. The average bioavailability exceeds 90% and is independent of dose,
which may produce a more predictable patient response. The elimination half-life
of pregabalin ranges between 5.5 and 6.7 hours and is independent of dose.9,11
Due to these specific properties of pregabalin, preoperative single dose administration
is effective in postoperative pain therapy with no need for long-term
treatment.12
Although opioids continue to have an important role in postoperative pain management,
they have side effects.13,14 For this reason, multimodal analgesia was
suggested to improve postoperative analgesia and to reduce opioid-related side
effects.15 An antineuropathic pain drug like pregabalin, as a part of multimodal
analgesia, can be useful for optimization of postoperative analgesia.7,8,12,16 Early
preclinical studies suggesting analgesic efficacy after tissue injury led to the development
of gabapentin and pregabalin as treatments for postoperative pain.17,18
Preoperative administration of 600 mg pregabalin, but not 300 mg, significantly
reduced opioid usage in patients after laparoscopic hysterectomy.7 In addition, a
study reported that 75 and 150 mg doses of pregabalin did not reduce postoperative
