As well as being opioid-sparing and curbing postoperative pain, preoperative pregabalin helps quell subsequent nausea and vomiting, according to a new meta-analysis.
As Dr. Michael C. Grant told Reuters Health by email, “The findings of our review suggest that patients may benefit from the dual effects of drugs such as pregabalin. Providers who are already utilizing pregabalin for perioperative pain relief may now recognize its efficacy as an antiemetic as well.”
Dr. Grant of The Johns Hopkins Medical Institutions, Baltimore, Maryland and colleagues conducted a meta-analysis of 23 randomized trials. These involved almost 1,700 patients undergoing general anesthesia, the team reports in a paper online July 26 in Anesthesia & Analgesia.
At 24 hours, preoperative pregabalin had produced a marked reduction in postoperative nausea and vomiting (PONV), with a risk ratio of 0.53 (p=0.0001). There were also significant reductions in nausea the (RR, 0.62) and vomiting (RR, 0.68).
Subgroup analysis allowing for major PONV confounders, such as prophylactic antiemetics and repeat dosing, and including high-risk surgery, showed similar antiemetic efficacy. Preoperative pregabalin administration also led to a significant reduction in opioid requirement over 24 hours.
There was a significant increase in postoperative visual disturbance (RR, 3.11) with pregabalin, although it had no effect on the incidence of sedation, dizziness, or headache.
The researchers note that perioperative enhanced-recovery protocols have increasingly introduced nonopioid alternatives such as gabapentin and pregabalin. Although “gabapentin has also been vetted for its antiemetic potential, little has been published to date regarding the potential efficacy of the related drug, pregabalin.”
Preoperative administration of pregabalin, they add, has been “shown to reduce nausea, vomiting, and rescue antiemetic administration within 24 hours of surgery performed under general anesthesia.”
Thus, concluded Dr. Grant, the finding “provides another arrow in the quiver of providers seeking to utilize a multimodal approach to patient care. This certainly requires additional work including appropriate dosing, timing, and mechanistic considerations. But it’s an intriguing start.”