Effect of pregabalin and dexamethasone addition to multimodal analgesia on postoperative analgesia following rhinoplasty surgery

Overview

Pain after rhinoplasty is usually managed with opioids, which cause nausea and sedation. The authors tested whether adding pregabalin, a nerve pain drug, alone or with the steroid dexamethasone, to a multimodal pain regimen would lower pain scores and opioid use in the first day.

Sections of note

• 60 patients randomized to three groups: placebo plus placebo (C), pregabalin plus placebo (P), pregabalin plus dexamethasone (PD).
• Doses: pregabalin 300 mg orally 1 hour before surgery; dexamethasone 8 mg intravenously at induction.
• Postoperative pain treated with patient-controlled intravenous tramadol, 20 mg bolus, 45-minute lockout.
• Median pain scores at 0, 1 and 6 hours were higher in group C than group PD (p < 0.001 for all).
• 24-hour tramadol and pethidine use lower in groups P and PD than C (p < 0.01).
• Total tramadol reduced 54.5% in P and 81.9% in PD versus C (p < 0.001).
• Nausea more frequent in C than P or PD (p < 0.05); blurred vision more frequent in P and PD (p < 0.05).
• Level of evidence I.

What it means for a patient

• One tablet of pregabalin before surgery, with or without a steroid dose, meant much less opioid was needed afterward and less nausea.
• Blurred vision for the first day was the trade-off.
• 20 patients per group at one center; the abstract does not report pain beyond 24 hours or any effect on swelling.

Why this paper matters

It is a randomized trial supporting opioid-sparing premedication for rhinoplasty, at a time when reducing opioid exposure was becoming a priority. Optimal dosing and effects beyond the first day remain to be defined.

Terms

• Pregabalin: a drug for nerve pain and seizures, used here as a preoperative painkiller.
• Dexamethasone: a steroid that reduces inflammation, swelling and nausea.
• Multimodal analgesia: combining several pain treatments that work in different ways.
• Patient-controlled analgesia: a pump that lets the patient self-administer set doses of painkiller.
• Tramadol: an opioid-type painkiller.
• Numeric rating scale: a 0 to 10 pain score reported by the patient.