Similar 48-H Analgesic Effects of Pre Vs. Post-Operative Pregabalin in Orthopaedic Oncological Patients: A Randomised Double-Blind Placebo-Controlled Trial

Background: Pain after the excision of orthopaedic-oncologic lesions is intense, and its suppression requires unusual measures. Multimodal analgesia, the currently preferred analgesic methodology, consists of two or more drugs administered concurrently, an approach that induces better analgesia than if using a single agent. Pregabalin is an analgesia adjuvant that is increasingly administered perioperatively. Its 24-h pre- vs. 24-h post-incisional analgesic effects have never been compared in orthopaedic-oncologic patients.
Methods: We compared prospectively, double-blindly and randomly the 48-h postoperative analgesic requirements and numerical pain scores following the administration of pregabalin 150 mg twice daily before surgery and placebo after surgery (the PRE group) versus placebo before surgery and pregabalin after surgery (the POST group), in 50 patients undergoing small bone and soft tissue tumour resection.
Results: Both groups had similar American Society of Anaesthesiologists class, age and weight values. Both protocols resulted in similar patient-rated pain scales. The immediate (48-h) total consumption of opioids and non-opioid analgesics, as well as their late (3 and 6 months) usage were lower in the POST group. Neither group reported significant adverse events.
Conclusion: Either 24-h pre- or postoperative pregabalin (150 mg bid) provides similar 48-h analgesia after minor orthopaediconcologic lesion resections. However, pregabalin postoperative coadjuvation spares opioids or non-steroidal anti-inflammatory drug usage.