普瑞巴林剂量对腹腔镜子宫全切术患者术后疼痛的影响

Dose ranging effects of Pregabalin on pain in patients undergoing laparoscopic hysterectomy

摘要:

探讨不同剂量（75、150和300 mg）普瑞巴林预先给药在腹腔镜子宫切除术患者中的术后镇痛效果。方法 该研究为前瞻性、随机、安慰剂对照和双盲研究。共纳入82例美国麻醉医师协会（ASA）分级为Ⅰ～Ⅱ级并择期行腹腔镜子宫切除术的患者。患者随机分成4组，其中第1、2和3组（每组20例）术前1晚、术前30 min和术后6 h分别口服浓度为75、150和300 mg的普瑞巴林，而对照组（n =22）按照相同方案接受安慰剂治疗。主要临床结局是术后24 h静息和运动时的疼痛视觉模拟评分（VAS）。药物相关副作用评估作为次要观察指标。嗜睡采用Ramsay镇静评分评估，而恶心和呕吐用数值评分评估。结果 不同浓度预先普瑞巴林给药的镇痛效果优于安慰剂。事后检验显示，4组间AVS评分差异有统计学意义，表明浓度下降，疼痛评分作为时间自变量而下降。普瑞巴林浓度达到最高（300 mg）时，镇静评分高于其他组。结论 预先服用75、150和300 mg普瑞巴林对减轻腹腔镜子宫切除术后疼痛具有重要作用。比较不同浓度与副作用表明，口服150 mg普瑞巴林是减轻腹腔镜子宫切除术后疼痛的安全有效方法。

Abstract:

To investigate the preemptive analgesia efficacy of different concentrations (75, 150 and 300 mg) of preemptive Pregabalin for the postoperative pain management after laparoscopic hysterectomy.?Methods?It was designed as a prospective, randomized, placebo-controlled, double-blind study. 82 women with American Association of Anesthesiologist (ASA) physical status I and II underwent elective laparoscopic hysterectomy surgery. Then all the patients were randomly assigned to four groups, of which groups 1 ~ 3 (treatment groups; n = 20) received orally Pregabalin concentrations of 75 mg, 150 mg, and 300 mg, respectively, for a night before surgery, 30 min before surgery and 6 h after surgery, whereas group 4 (control group; n = 22) received a matching dosage of placebo at the same scheme. Visual Analog Scale (VAS) scores for postoperative pain at rest and on movement at first 24 h after surgery were evaluated as primary outcome. Drug-related side effects were also evaluated as a secondary outcome. Somnolence was evaluated using Ramsay sedation scale, while nausea and vomiting were assessed using numeric scores. The data were analyzed using SPSS.?Results?Preemptive Pregabalin in different concentrations provided better pain relief as compared with placebo. Post-hoc test indicated that there was a significant difference in VAS of the four groups, indicating where the concentration was increased, the pain score decreased as an independent variable of time. The highest concentration of Pregabalin (300 mg) revealed higher sedation scores as compared with other groups.?Conclusion?Our data demonstrated preemptive administration of 75, 150, and 300 mg Pregabalin play an important role in reducing postoperative pain after laparoscopic hysterectomy. Comparison of different concentrations and side effects indicates oral administration of 150 mg Pregabalin is an effective and safe method for postoperative pain management after laparoscopic hysterectomy.