1. Ayman A. El-Rashidy* Ahmed M. Khattab** Zeinab A. El-Seify***
Preoperative Pregabalin Supplementation of Peribulbar Block during Vitrectomy Surgery
(Can Oral Pregabalin Replace the Need for I.V. Sedatives/Analgesics during Regional Blocks?)
Ayman A. El-Rashidy* Ahmed M. Khattab** Zeinab A. El-Seify***
* Consultant Anesthesiologist, Magrabi Medical Center, Doha, Qatar & Ass. Professor of Anesthesia, F. of Medicine, Tanta University, Egypt.
** Consultant Anesthesiology, Queen Medical, Doha, Qatar & Ass. Professor of Anesthesia, F. of Medicine, Ain Shams University, Egypt (Presenting Author)
*** Consultant Anesthesiologist, Al-Ahli Hospital, Doha, Qatar. .
Background:
 Vitrectomy is a commonly performed eye surgery in elderly and occasionally high risk group patients. Although local anesthesia appears as a safe and effective choice, yet a cooperative patient, akinetic eye, and profound anesthesia of the surgical site are essential components for a successful outcome.
The use of I.V. sedatives and/or opioids is a common practice to reduce anxiety and supplement local anesthesia, but with frequent complications (variability of patient response, undesirable deep sedation up to respiratory depression, and hemodynamic instability).
Pregabalin (a potent ligand for the alpha-2-delta subunit of voltage-gated calcium channels in the CNS) exhibits a potent analgesic and anxiolytic activities [1, 2] It has been successfully introduced as an adjunct to managing acute postoperative pain [3] There is lack of trials investigating the role of preoperative pergabalin in attenuating the anxiety and pain associated with ophthalmic regional blocks.
Peribulbar Block
Cooperation & Satisfaction Scores
Objectives
This study aimed primarily to test the effect of preoperative pergabalin administration on reducing the pain and anxiety associated with the peribulbar block in patients undergoing Vitrectomy. Secondary aims were to measure both the patient & surgeon satisfactions at the end of the procedure.
Analgesics/Sedative Consumption
Discussion
Methods
In the present study, premedicating vitrectomy patients with pregabalin 150 mg provided less anxiety and pain during the insertion of local anesthesia needle, along with better patient satisfaction in comparison patients received placebo.
Pregabalin was shown to be effective in several models of neuropathic pain, incisional injury, and inflammatory injury. It is effective in the treatment of anxiety, and is also a sleep-modulating drug [4].
Systematic review of pregabalin supports its efficacy and safety in perioperative settings [4]. One study showed its additive analgesic effects for patients with incomplete neural block [5].
Its favorable pharmacokinetics, along with the least side effects, should strengthen its use as a multipurpose premedication drug before regional ophthalmic blocks.
This is a Prospective, Randomized, and Double-Blind Controlled Study.
• A total of 58 Vitrectomy patients completed the study. They were divided into 2 groups:
* Pregabalin Group (30 pts.) ingested 150mg Pregabalin (Lyrica®) 90 minutes before the start of regional eye block.
* Control Group (28 pts.) ingested placebo capsules.
• "Peribulbar Block (PB)" after topical anesthesia by the same anesthetist = Lidocaine 2% (2.5mL) + Levobupivacaine 0.25% (7.5 mL) + Hyaluronidase (150 IU) into the medial canthus.
•Observations: * Anxiety & Sedation (just before PB)
* Pain Scores (during PB)
* Total Need for Analgesics /Sedatives.
* Patient Cooperation & Satisfaction.
* Surgeon Satisfaction.
Sedation Scores
Anxiety Scores
References
Results
[1] Ben-Menachem E. Pregabalin pharmacology and its relevance to clinical practice. Epilepsia 2004; 45 (suppl 6):13–18.
[2] Tiippana EM, Hamunen K, Kontinen VK, Kalso E: Do surgical patients benefit from perioperative gabapentin/pergabalin? A systematic review of efficacy and safety. Anesth Analg 2007; 104:1545–1556.
[3] Engelman E, Cateloy F: Efficacy and safety of perioperative pergabalin for post-operative pain: a meta-analysis of randomized-controlled trials. Acta Anaesthesiol Scand 2011; 55:927–943.
[4] Noor M. Gajraj: Pregabalin: Its Pharmacology and Use in Pain Management. Anesth Analg 2007; 105:1805–15.
[5] S.R. Clendenen, S. Rajendran, D.J. Kopacz et al. Pregabalin as an adjunct to a multimodal analgesic regimen to achieve opioid sparing in arthroscopic rotator cuff repair. Jurnalul Român de Anestezie 2010; 17 (1), 5-10.
- Anxiety and pain scores in the Pregabalin Group were significantly lower than those in the Control Group (3+1.3 vs , P <0.001 and vs , P <0.05, respectively).
- Patients in the Pregabalin Group were mildly sedated and expressed higher satisfaction scores in comparison to those in the Control Group (P<0.05).
- Intravenous Fentanyl and Midazolam requirements were significantly less in Pregabalin Group patients.
Pain Scores