Sparing analgesic effect using pregabaline in postsurgical trauma patients in the ICU

Introduction

Pregabaline (Lyrica^®) a γ-aminobutyric acid analogue, reduces neuropathic pain more than placebo does and is well tolerated [1]. We wanted to determine the possible sparing effect over piritramide demands when pregabaline was given as soon as acute pain occurred in postsurgical trauma patients.

Methods

Thirty-three polytrauma patients needing orthopaedic surgery were admitted to our ICU during a 10-month period of time. On average, enteral feeding could be given 2 days after surgery and the prospective double-blind randomized study began thereafter. Two groups were defined: the control group (Gc: n = 21) receiving placebo every day via nasogastric tube, and the second group (Gp: n = 22) receiving pregabaline using the same route (T1: days 1–2, 75 mg/12 hours; T2: days 3–7, 150 mg/12 hours; T3: days 8–35, 300 mg/12 hours). Every patient received intravenously perfusalgan (1 g/6 hours) and piritramide via an infusion pump for patient-controlled analgesia (bolus 2 mg/10 min with a maximal dose of 12 mg/hour) when the Visual Analogue Scale was over 4. Piritramide consumption (Pc: total bolus delivery) was noted every day in every group. This study was approved by the Ethics Committee of the Centre Hospitalier Kirchberg and informed consent was obtained for each patient via family members. For statistical analysis a Shapiro–Wilk test, Wilcox test and a Student t test were used.

Results

Demographic data were comparable in both groups in terms of age (38 ± 19 years), gender (32% female in Gc vs 35% in Gp) and injuries (ISS: 18 ± 8). The total mean hospitalisation time in ICU was similar in both groups (Gc: 25 ± 6 days; Gp: 22 ± 10 days). In Gp two patients died at days 11 and 16 from septic complications, in Gc three patients died at days 8, 19 and 22 from septic shock, lung emboly and multiple organ failure. The average Pc values at T1 do not differ significantly between groups (Gc: 36 ± 2; Gp 33 ± 2). At T2 significant differences appeared showing a decrease in Pc by 22% in Gc (28 ± 2) and by 42% in Gp (19 ± 1) (P < 0.005). At T3 a more significant decrease of 78% in Pc was observed in Gp (4 ± 4) and of 46% in Gc (15 ± 6) (P < 0.002). No neurological adverse effects were described in Gp.

Conclusion

In this study, pregabaline was used for the first time as a preventive analgesic drug and showed its importance by sparing piritramide consumption in postsurgical trauma patients. Pain control became more efficient by diminishing stress and thus co-morbidity factors. This could effectively reduce the future occurrence of chronic pain, cost and thus improve quality of life upon discharge from the hospital.