Effects of Pregabalin as Preemptive Analgesia for Pain Score, Sedation Score, and Cortisol Level after Caesarean Section Under Spinal Anesthesia

Authors

  • Muhammad Ramli Ahmad Department of Anesthesiology, Intensive Care, and Pain Management, Faculty of Medicine, Hasanuddin University-Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia image/svg+xml
  • Ardiansyah Siradjuddin Department of Anesthesiology, Intensive Care, and Pain Management, Faculty of Medicine, Hasanuddin University-Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia
  • Syafruddin Gaus Department of Anesthesiology, Intensive Care, and Pain Management, Faculty of Medicine, Hasanuddin University-Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia image/svg+xml
  • Syafri Kamsul Arif Department of Anesthesiology, Intensive Care, and Pain Management, Faculty of Medicine, Hasanuddin University-Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia image/svg+xml
  • Alamsyah Ambo Ala Husain Department of Anesthesiology, Intensive Care, and Pain Management, Faculty of Medicine, Hasanuddin University-Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia image/svg+xml
  • Andi Adil Department of Anesthesiology, Intensive Care, and Pain Management, Faculty of Medicine, Hasanuddin University-Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia image/svg+xml

DOI:

https://doi.org/10.3889/oamjms.2023.10859

Keywords:

Pregabalin, preemptive analgesia, Caesarean section, spinal anesthesia

Abstract

INTRODUCTION: Cesarean  section  (C-section)  is  an  increasingly  common  method  of  delivery,  so  optimal management of anesthesia and post-operative pain is essential for better outcomes. Preemptive analgesia is an effective method for preventing post-operative pain, with the benefits of pregabalin specifically being much studied and debated. This study aimed to determine the side effects and efficacy of different pregabalin doses for pain management and prevention of stress response in C-section patients under spinal anesthesia.

MATERIALS AND METHODS: This double-blind randomized trial study examined 30 patients who underwent elective C-section under spinal anesthesia with 0.5% hyperbaric bupivacaine 10 mg + adjuvant fentanyl 25 mcg, who were divided into three equal groups which received oral placebo or pregabalin (75 or 150 mg). Pain scores, sedation scores, and cortisol levels and changes were analyzed, the former two using Mann–Whitney tests, cortisol levels using one-way Analysis of variance (ANOVA) tests, and cortisol level changes using repeated-measures ANOVA tests on SPSS software version 20. Results were considered significant when p < 0.05.

RESULTS: There were significant differences in numerical rating scale between the placebo and pregabalin groups at rest and movement after surgery (p < 0.05), and in sedation scores between the placebo and 150 mg groups and between the 75 mg and 150 mg groups at 2 and 6-h post-surgery (p < 0.05), as well as cortisol level changes between all groups (p < 0.05).

CONCLUSIONS: Preemptive administration of pregabalin 75 mg is recommended for C-section surgery because it may reduce post-operative pain with minimal side effects.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

Author Biography

Muhammad Ramli Ahmad, Department of Anesthesiology, Intensive Care, and Pain Management, Faculty of Medicine, Hasanuddin University-Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia

Department of Anesthesiology, Intensive Care, and Pain Management, Faculty of Medicine Hasanuddin University – Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia

References

Kissin I, Weiskopf RB. Preemptive analgesia. Anesthesiology. 2000;93:1138-43. https://doi.org/10.1097/00000542-200010000-00040 DOI: https://doi.org/10.1097/00000542-200010000-00040

Schmidt PC, Ruchelli G, Mackey SC, Carroll IR. Perioperative gabapentinoids: Choice of agent, dose, timing, and effects on chronic postsurgical pain. Anesthesiology. 2013;119(5):1215-21. https://doi.org/10.1097/ALN.0b013e3182a9a896 PMid:24051389 DOI: https://doi.org/10.1097/ALN.0b013e3182a9a896

Helander EM, Menard BL, Harmon CM, Homra BK, Allain AV, Bordelon GJ, et al. Multimodal analgesia, current concepts, and acute pain considerations. Curr Pain Headache Rep. 2017;21(1):3. https://doi.org/10.1007/s11916-017-0607-y PMid:28132136 DOI: https://doi.org/10.1007/s11916-017-0607-y

Betrán AP, Ye J, Moller AB, Zhang J, Gülmezoglu AM, Torloni MR. The increasing trend in caesarean section rates: Global, regional and national estimates: 1990-2014. PLoS One. 2016;11(12):e0148343. https://doi.org/10.1371/journal.pone.0148343 PMid:26849801 DOI: https://doi.org/10.1371/journal.pone.0148343

Betran AP, Ye J, Moller AB, Souza JP, Zhang J. Trends and projections of caesarean section rates: Global and regional estimates. BMJ Glob Health. 2021;6(6):e005671. https://doi.org/10.1136/bmjgh-2021-005671 PMid:34130991 DOI: https://doi.org/10.1136/bmjgh-2021-005671

Wyatt S, Silitonga PI, Febriani E, Long Q. Socioeconomic, geographic and health system factors associated with rising C-section rate in Indonesia: A cross-sectional study using the Indonesian demographic and health surveys from 1998 to 2017. BMJ Open. 2021;11(5):e045592. https://doi.org/10.1136/bmjopen-2020-045592 PMid:34020977 DOI: https://doi.org/10.1136/bmjopen-2020-045592

Karnina R, Rahmadani S, Faruk M. Incidence of hypotension, bradycardia, and post-operative nausea and vomiting with spinal anesthesia in cesarean section patient. Open Access Maced J Med Sci. 2022;10(B):1602-6. https://doi.org/10.3889/oamjms.2022.9024 DOI: https://doi.org/10.3889/oamjms.2022.9024

Baloyiannis I, Theodorou E, Sarakatsianou C, Georgopoulou S, Perivoliotis K, Tzovaras G. The effect of preemptive use of pregabalin on postoperative morphine consumption and analgesia levels after laparoscopic colorectal surgery:Acontrolled randomized trial. Int J Colorectal Dis. 2019;35(2):323-31. https://doi.org/10.1007/s00384-019-03471-3 PMid:31863206 DOI: https://doi.org/10.1007/s00384-019-03471-3

Sebastian B, Talikoti AT, Nelamangala K, Krishnamurthy D. Effect of oral pregabalin as preemptive analgesic in patients undergoing lower limb orthopedic surgeries under spinal anaesthesia. J Clin Diagn Res. 2016;10(7):UC01-4. https://doi.org/10.7860/JCDR/2016/18854.8081 PMid:27630927 DOI: https://doi.org/10.7860/JCDR/2016/18854.8081

Omara AF, Ahmed SA, Abusabaa MM. The effect of the use of preemptive oral pregabalin on the postoperative spinal analgesia in patients presented for orthopedic surgeries: Randomized Controlled Trial. J Pain Res. 2019;12:2807-14. https://doi.org/10.2147/JPR.S216184 PMid:31686901 DOI: https://doi.org/10.2147/JPR.S216184

Kien NT, Geiger P, Van Chuong H, Cuong NM, Van Dinh N, Pho DC, et al. Preemptive analgesia after lumbar spine surgery by pregabalin and celecoxib: A prospective study. Drug Des Devel Ther. 2019;13:2145-52. https://doi.org/10.2147/DDDT. S202410 PMid:31308627 DOI: https://doi.org/10.2147/DDDT.S202410

Fabritius ML, Strøm C, Koyuncu S, Jæger P, Petersen PL, Geisler A, et al. Benefit and harm of pregabalin in acute pain treatment: A systematic review with meta-analyses and trial sequential analyses. Br J Anaesth. 2017;119(4):775-91. https://doi.org/10.1093/bja/aex227 PMid:29121288 DOI: https://doi.org/10.1093/bja/aex227

Sisa K, Huoponen S, Ettala O, Antila H, Saari TI, Uusalo P. Effects of pre-emptive pregabalin and multimodal anesthesia on postoperative opioid requirements in patients undergoing robot- assisted laparoscopic prostatectomy. BMC Urol. 2021;21(1):14. https://doi.org/10.1186/s12894-021-00785-9 PMid:33530959 DOI: https://doi.org/10.1186/s12894-021-00785-9

Karnina R, Rahayu NS, Faruk M. Factors influencing Bromage score in post-spinal anesthesia patients. Bali Med J. 2022;11(3):1146-50.

Lazaridou A, Elbaridi N, Edwards RR, Berde CB. Pain assessment. In: Benzon HT, Raja SN, Fishman SM, Liu SS, Cohen SP, editors. Essentials Pain Med. 4th ed. Philadelphia, PA: Elsevier; 2018. p. 39-46.e1. https://doi.org/10.1016/B978-0-323-40196-8.00005-X DOI: https://doi.org/10.1016/B978-0-323-40196-8.00005-X

Namigar T, Serap K, Esra AT, Özgül O, Can OA, Aysel A, et al. The correlation among the Ramsay sedation scale, Richmond agitation sedation scale and Riker sedation agitation scale during midazolam-remifentanil sedation. Rev Bras Anesthesiol. 2017;67(4):347-54. https://doi.org/10.1016/j.bjane.2016.07.002 PMid:28412050 DOI: https://doi.org/10.1016/j.bjane.2016.07.002

Agarwal A, Gautam S, Gupta D, Agarwal S, Singh PK, Singh U. Evaluation of a single preoperative dose of pregabalin for attenuation of postoperative pain after laparoscopic cholecystectomy. Br J Anaesth. 2008;101(5):700-4. https://doi.org/10.1093/bja/aen244 PMid:18716003 DOI: https://doi.org/10.1093/bja/aen244

Eskandar AM, Ebeid AM. Effect of pregabalin on postoperative pain after shoulder arthroscopy. Egypt J Anaesth. 2013;29(4):363-7. https://doi.org/10.1016/j.egja.2013.07.001 DOI: https://doi.org/10.1016/j.egja.2013.07.001

Widyadharma IP. Efektivitas pregabalin untuk terapi nyeri kronis: Evidence-based review. Cermin Dunia Kedokt. 2015;42(3):204-7.

Bala R, Kaur J, Sharma J, Singh R. Comparative evaluation of pregabalin and clonidine as preemptive analgesics for the attenuation of postoperative pain following thoracolumbar spine surgery. Asian Spine J. 2019;13(6):967-75. https://doi.org/10.31616/asj.2019.0031 PMid:31352721 DOI: https://doi.org/10.31616/asj.2019.0031

Mulyono BS, Rahardjo SS. Perbandingan perubahan nilai rate pressure product pada laringointubasi endotrakea antara premedikasi pregabalin 225 Mg dengan clonidin 0,15 MG per oral. J KOMPLIKASI ANESTESI. 2017;4:1-15.

Naby SM, Kamel AA, Abdelghany A, Salem DA. The effects of pre-emptive single dose oral pregabalin on maternal anxiety and stress response to laryngoscopic intubation during caesarean section. Egypt J Anaesth. 2021;37(1):214-20. https://doi.org/10.1080/11101849.2021.1920137 DOI: https://doi.org/10.1080/11101849.2021.1920137

Meena R, Meena K, Prakash S. Study of attenuation of cardiovascular response during laryngoscopy and intubation using two different doses of pregabalin as premedication in controlled hypertensive patients-A RCT. J Anesth Clin Res. 2016;7:2. https://doi.org/10.4172/2155-6148.1000607 DOI: https://doi.org/10.4172/2155-6148.1000607

Rastogi B, Gupta K, Gupta PK, Agarwal S, Jain M, Chauhan H. Oral pregabalin premedication for attenuation of haemodynamic pressor response of airway instrumentation during general anaesthesia: A dose response study. Indian J Anaesth. 2012;56(1):49-54. https://doi.org/10.4103/0019-5049.93344 PMid:22529420 DOI: https://doi.org/10.4103/0019-5049.93344

Gajraj NM. Pregabalin: Its pharmacology and use in pain management. Anesth Analg. 2007;105(6):1805-15. https://doi.org/10.1213/01.ane.0000287643.13410.5e PMid:18042886 DOI: https://doi.org/10.1213/01.ane.0000287643.13410.5e

Vranken JH. Mechanisms and treatment of neuropathic pain. Cent Nerv Syst Agents Med Chem. 2009;9:71-8. https://doi.org/10.2174/187152409787601932 PMid:20021340 DOI: https://doi.org/10.2174/187152409787601932

Hall GC, Morant SV, Carroll D, Gabriel ZL, McQuay HJ. An observational descriptive study of the epidemiology and treatment of neuropathic pain in a UK general population. BMC Fam Pract. 2013;14:28. https://doi.org/10.1186/1471-2296-14-28 PMid:23442783 DOI: https://doi.org/10.1186/1471-2296-14-28

Celic-Spuzic E. Effect of anesthesia on the changes in the hormones levels during and after transvesical prostatectomy. Med Arh. 2011;65(6):348-53. PMid:22299297 DOI: https://doi.org/10.5455/medarh.2011.65.348-353

Karaman S, Kocabas S, Uyar M, Zincircioglu C, Firat V. Intrathecal morphine: Effects on perioperative hemodynamics, postoperative analgesia, and stress response for total abdominal hysterectomy. Adv Ther. 2006;23:295-306. https://doi.org/10.1007/BF02850135 PMid:16751162 DOI: https://doi.org/10.1007/BF02850135

Seyedhejazie M, Madarek E. The effect of small dose bupivacaine-fentanyl in spinal anesthesia on hemodynamic nausea and vomiting in cesarean section. Pak J Med Sci. 2007;23(50):747-50.

Downloads

Published

2023-01-02

How to Cite

1.
Ahmad MR, Siradjuddin A, Gaus S, Arif SK, Husain AAA, Adil A. Effects of Pregabalin as Preemptive Analgesia for Pain Score, Sedation Score, and Cortisol Level after Caesarean Section Under Spinal Anesthesia. Open Access Maced J Med Sci [Internet]. 2023 Jan. 2 [cited 2024 Apr. 29];11(B):88-93. Available from: https://oamjms.eu/index.php/mjms/article/view/10859

Most read articles by the same author(s)

Similar Articles

1 2 3 4 > >> 

You may also start an advanced similarity search for this article.