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Oral pregabalin for postoperative pain relief after third molar extraction: a randomized controlled clinical trial

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Abstract

Objectives

The aim of this randomized controlled clinical trial was to evaluate the efficacy and safety of pregabalin administered pre- and postoperatively in patients with pain and swelling due to the surgical removal of impacted lower third molars.

Materials and methods

The final study sample comprised 60 volunteers (23 males and 37 females). Group 1 (n = 30) received 75 mg oral pregabalin 1 h before surgery and 1 h after surgery. Group 2 (n = 30) served as a control group and received no pregabalin. Both groups were administered with 650 mg paracetamol every 8 h for 2 days. Postoperative pain intensity and swelling were measured using a visual analog scale (VAS); pain relief experienced was reported using a four-point verbal rating scale (VRS); the rescue medication requirement, adverse effects, and global impression of the medication were also recorded.

Results

No significant difference in pain intensity (VAS) was observed between the groups. However, fewer rescue medication tablets were needed by pregabalin-treated patients than by controls (p = 0.021). The frequency and intensity of adverse effects were significantly higher in pregabalin-treated patients (p < 0.001), although no serious adverse events occurred. No significant difference in the degree of swelling was observed in any measurement except that from mandibular angle to lip junction, which showed lesser inflammation in the pregabalin group at 24 h post-surgery (p = 0.011). The global opinion on the medication received was more positive in the pregabalin group (p = 0.042).

Conclusions

The administration of pregabalin reduces the requirement for rescue medication after third molar surgery and results in a more constant pain level, with fewer peaks of pain intensity.

Clinical relevance

These findings suggest that pregabalin may be useful to control acute postoperative pain. Adverse effects are known to be reduced at the low pregabalin dose used in our study.

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References

  1. Hill CM, Balkenohl M, Thomas DW, et al. (2001) Pregabalin in patients with postoperative dental pain. Eur J Pain 5:119–124

    Article  PubMed  Google Scholar 

  2. Golembiewski JA (2007) Postoperative pain management–is there a role for gabapentin or pregabalin? J Perianesthesia Nurs 22:136–138

    Article  Google Scholar 

  3. Kang S-H, Choi Y-S, Byun I-Y, Kim M-K (2010) Effect of preoperative prednisolone on clinical postoperative symptoms after surgical extractions of mandibular third molars. Aust Dent J 55:462–467

    Article  PubMed  Google Scholar 

  4. Paech MJ, Goy R, Chua S, et al. (2007) A randomized, placebo-controlled trial of preoperative oral pregabalin for postoperative pain relief after minor gynecological surgery. Anesth Analg 105:1449–1453

    Article  PubMed  Google Scholar 

  5. Cooper SA (1988) Ketoprofen in oral surgery pain: a review. J Clin Pharmacol 28:S40–S46

    Article  PubMed  Google Scholar 

  6. Urquhart E (1994) Analgesic agents and strategies in the dental pain model. J Dent 22:336–341

    Article  PubMed  Google Scholar 

  7. Cousins MJ, Brennan F, Carr DB (2004) Pain relief: a universal human right. Pain 112:1–4

    Article  PubMed  Google Scholar 

  8. Merry AF, Gibbs RD, Edwards J, et al. (2010) Combined acetaminophen and ibuprofen for pain relief after oral surgery in adults: a randomized controlled trial. Br J Anaesth 104:80–88

    Article  PubMed  PubMed Central  Google Scholar 

  9. Ianiro SR, Jeansonne BG, McNeal SF, Eleazer PD (2007) The effect of preoperative acetaminophen or a combination of acetaminophen and ibuprofen on the success of inferior alveolar nerve block for teeth with irreversible pulpitis. J Endod 33:11–14

    Article  PubMed  Google Scholar 

  10. Stacey BR, Dworkin RH, Murphy K, et al. (2008) Pregabalin in the treatment of refractory neuropathic pain: results of a 15-month open-label trial. Pain Med Malden Mass 9:1202–1208

    Article  Google Scholar 

  11. Kim SY, Song JW, Park B, et al. (2011) Pregabalin reduces post-operative pain after mastectomy: a double-blind, randomized, placebo-controlled study. Acta Anaesthesiol Scand 55:290–296

    Article  PubMed  Google Scholar 

  12. Buvanendran A, Kroin JS, Della Valle CJ, et al. (2010) Perioperative oral pregabalin reduces chronic pain after total knee arthroplasty: a prospective, randomized, controlled trial. Anesth Analg 110:199–207

    Article  PubMed  Google Scholar 

  13. Gajraj NM (2007) Pregabalin: its pharmacology and use in pain management. Anesth Analg 105:1805–1815

    Article  PubMed  Google Scholar 

  14. Ben-Menachem E (2004) Pregabalin pharmacology and its relevance to clinical practice. Epilepsia 45(Suppl 6):13–18

    Article  PubMed  Google Scholar 

  15. Shneker BF, McAuley JW (2005) Pregabalin: a new neuromodulator with broad therapeutic indications. Ann Pharmacother 39:2029–2037

    Article  PubMed  Google Scholar 

  16. Chizh BA, Göhring M, Tröster A, et al. (2007) Effects of oral pregabalin and aprepitant on pain and central sensitization in the electrical hyperalgesia model in human volunteers. Br J Anaesth 98:246–254

    Article  PubMed  Google Scholar 

  17. Guay DRP (2005) Pregabalin in neuropathic pain: a more “pharmaceutically elegant” gabapentin? Am J Geriatr Pharmacother 3:274–287

    Article  PubMed  Google Scholar 

  18. Frampton JE, Foster RH (2005) Pregabalin: in the treatment of postherpetic neuralgia. Drugs 65:111–118 discussion 119–120

    Article  PubMed  Google Scholar 

  19. Coderre TJ, Kumar N, Lefebvre CD, Yu JSC (2005) Evidence that gabapentin reduces neuropathic pain by inhibiting the spinal release of glutamate. J Neurochem 94:1131–1139

    Article  PubMed  Google Scholar 

  20. Jones DL, Sorkin LS (1998) Systemic gabapentin and S(+)-3-isobutyl-gamma-aminobutyric acid block secondary hyperalgesia. Brain Res 810:93–99

    Article  PubMed  Google Scholar 

  21. Carretero Colomer M (2005) Pregabalina, actividad analgesica y antiepileptica. Medicam Vanguard 24:123–126

    Google Scholar 

  22. Tesfaye S, Wilhelm S, Lledo A, et al. (2013) Duloxetine and pregabalin: high-dose monotherapy or their combination? The “COMBO-DN study”–a multinational, randomized, double-blind, parallel-group study in patients with diabetic peripheral neuropathic pain. Pain 154:2616–2625

    Article  PubMed  Google Scholar 

  23. Chang S-H, Lee H-W, Kim H-K, et al. (2009) An evaluation of perioperative pregabalin for prevention and attenuation of postoperative shoulder pain after laparoscopic cholecystectomy. Anesth Analg 109:1284–1286

    Article  PubMed  Google Scholar 

  24. Peng PWH, Li C, Farcas E, et al. (2010) Use of low-dose pregabalin in patients undergoing laparoscopic cholecystectomy. Br J Anaesth 105:155–161

    Article  PubMed  Google Scholar 

  25. Mathiesen O, Jørgensen DG, Hilsted KL, et al. (2011) Pregabalin and dexamethasone improves post-operative pain treatment after tonsillectomy. Acta Anaesthesiol Scand 55:297–305

    Article  PubMed  Google Scholar 

  26. Cheung CW, Choi WS, Leung YY, et al. (2012) A double-blind randomized crossover study to evaluate the timing of pregabalin for third molar surgery under local anesthesia. J Oral Maxillofac Surg 70:25–30

    Article  PubMed  Google Scholar 

  27. Dodson TB (2007) A guide for preparing a patient-oriented research manuscript. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 104:307–315

    Article  PubMed  Google Scholar 

  28. Pell GJ, Gregory BT (1933) Impacted mandibular third molars: classification and modified techniques for removal. Dent Dig 39:330–338

    Google Scholar 

  29. Cillo Jr JE, Dattilo DJ (2014) Pre-emptive analgesia with pregabalin and celecoxib decreases postsurgical pain following maxillomandibular advancement surgery: a randomized controlled clinical trial. J Oral Maxillofac Surg 72:1909–1914

    Article  PubMed  Google Scholar 

  30. Aznar-Arasa L, Harutunian K, Figueiredo R, et al. (2012) Effect of preoperative ibuprofen on pain and swelling after lower third molar removal: a randomized controlled trial. Int J Oral Maxillofac Surg 41:1005–1009

    Article  PubMed  Google Scholar 

  31. Ferraiolo DM, Veitz-Keenan A (2014) Ibuprofen is superior to paracetamol for pain relief following third molar removal. Evid Based Dent 15:106–107

    Article  PubMed  Google Scholar 

  32. Mehra P, Reebye U, Nadershah M, et al. (2013) Efficacy of anti-inflammatory drugs in third molar surgery: a randomized clinical trial. Int J Oral Maxillofac Surg 42:835–842

    Article  PubMed  Google Scholar 

  33. Breivik EK, Björnsson GA (1998) Variation in surgical trauma and baseline pain intensity: effects on assay sensitivity of an analgesic trial. Eur J Oral Sci 106:844–852

    Article  PubMed  Google Scholar 

  34. Zhang J, Ho K-Y, Wang Y (2011) Efficacy of pregabalin in acute postoperative pain: a meta-analysis. Br J Anaesth 106:454–462

    Article  PubMed  Google Scholar 

  35. Jokela R, Ahonen J, Tallgren M, et al. (2008) Premedication with pregabalin 75 or 150 mg with ibuprofen to control pain after day-case gynaecological laparoscopic surgery. Br J Anaesth 100:834–840

    Article  PubMed  Google Scholar 

  36. Mishriky BM, Waldron NH, Habib AS (2015) Impact of pregabalin on acute and persistent postoperative pain: a systematic review and meta-analysis. Br J Anaesth 114:10–31

    Article  PubMed  Google Scholar 

  37. Katz J, Clarke H (2008) Preventive analgesia and beyond: current status, evidence, and future directions. In: EM P, Suellen MW, Rowbotham DJ (eds) Clinical pain management: acute pain. Arnold, London, p. 154

    Chapter  Google Scholar 

  38. McQuay HJ, Poon KH, Derry S, Moore RA (2008) Acute pain: combination treatments and how we measure their efficacy. Br J Anaesth 101:69–76

    Article  PubMed  Google Scholar 

  39. Lauria-Horner BA, Pohl RB (2003) Pregabalin: a new anxiolytic. Expert Opin Investig Drugs 12:663–672

    Article  PubMed  Google Scholar 

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Correspondence to Francisco J. Manzano-Moreno.

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All procedures involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

Conflict of interest

The authors declare that they have no conflict of interest.

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Olmedo-Gaya, M.V., Manzano-Moreno, F.J., Galvez-Mateos, R. et al. Oral pregabalin for postoperative pain relief after third molar extraction: a randomized controlled clinical trial. Clin Oral Invest 20, 1819–1826 (2016). https://doi.org/10.1007/s00784-015-1657-3

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  • DOI: https://doi.org/10.1007/s00784-015-1657-3

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