Pregabalin Does Not Reduce Opioid Consumption After Spinal Fusion

Giving adolescent patients pregabalin prior to instrumented posterior spinal fusion for spinal deformities does not reduce persistent pain or the consumption of opioids, according to a new study.

In the study, “Pregabalin and Persistent Postoperative Pain Following Posterior Spinal Fusion in Children and Adolescents,” published on December 1, 2021 in the Journal of Bone and Joint Surgery, researchers focused on adolescents and children 10 to 21 years old with a spinal deformity who were scheduled for pedicle screw instrumentation and fusion.

“Surgical correction of spinal deformity requires major surgical intervention with extensive manipulation of the spine and neural elements. Persistent postoperative pain affects patient quality of life and can also cause financial burden for patient families and for society,” they wrote.

Patients in the trial were randomized to their pregabalin or placebo. They either received 2 mg/kg of pregabalin or a placebo twice daily before surgery and for 5 days afterwards. Follow-up was for 2 years.

The primary outcomes were cumulative opioid consumption during the first 48 hours postoperative and the incidence of persistent postoperative pain of the 2-year period.

The final analysis included 64 patients. There was no significant difference in the cumulative 48-hour opioid consumption between the study groups.

Overall, the Scoliosis Research Society 24-Item Questionnaire pain domain score improved significantly, from a mean value of 3.8 in both groups to 4.3 in the pregabalin and 4.0 in the placebo group at 2 years postoperatively. There were no differences between the study groups at any time point (p = 0.317).

In addition, the Scoliosis Research Society total scores of the study groups were similar (p = 0.678). Additionally, back pain improved significantly (p = 0.001) with no significant differences at any time point (preoperatively and 6 months, 1 year and 2 years postoperatively).

“Perioperative pregabalin does not reduce postoperative opioid consumption or the incidence of persistent postoperative pain following instrumented posterior spinal fusion for spinal deformities in an adolescent population,” the researchers wrote.