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Clinical Study
  • Pregabalin Effect on Acute and Chronic Pain after Cardiac Surgery, Aik Bouzia, Vassilios Tassoudis, Menelaos Karanikolas, George Vretzakis, Argyro Petsiti, Nikolaos Tsilimingas, and Elena Arnaoutoglou
    Anesthesiology Research and Practice
    Clinical Study (7 pages), Article ID 2753962, Volume 2017 (2017)
    Published 30 April 2017
Anesthesiology Research and Practice
Volume 2018, Article ID 2603865, 2 pages
https://doi.org/10.1155/2018/2603865
Letter to the Editor

Comment on “Pregabalin Effect on Acute and Chronic Pain after Cardiac Surgery”

Department of Anesthesia, Ippokrateio Hospital, Thessaloniki, Greece

Correspondence should be addressed to Elena Theodorou; moc.liamg@anel.nam

Received 3 September 2017; Accepted 12 March 2018; Published 5 June 2018

Academic Editor: Ronald G. Pearl

Copyright © 2018 Elena Theodorou and Evagelia Bali. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


We have read with great interest the article entitled “Clinical Study: Pregabalin Effect on Acute and Chronic Pain after Cardiac Surgery” by Bouzia et al. [1]. We appreciate their effort for this clinical study, and we would like to make some comments as we believe that there are some flaws in its design and methodology.

First, it is not mentioned when exactly the patients received the single dose of the “study drug” and if there was any delay in the extubation time. In other studies, the results were unstable as time to extubation was significantly longer in the pregabalin group [2, 3] or similar between groups [4, 5].

The visual analogue scale (VAS) and numeric rate scale (NRS) are equally sensitive in assessing acute pain after surgery, and they are both superior to VRS, but the authors chose to use the verbal rating scale (VRS) for assessment of pain intensity, although they finally describe the numeric rate scale. It is remarkable that VRS can be converted to numeric scores for charting and easy comparison, but the authors did not mention or explain this option.

We think that the whole plan of postoperative analgesia has many limitations. First, it is not clear when the patients received the initial dose of morphine (5 mg). Also, they preferred to use a background infusion with the programmable PCA pump and a too long lockout interval combined with a bolus dose of 0.5 mg morphine. Additionally, they provided rescue analgesia with IV morphine if the above scheme with the pump was not sufficient.

It is well known that chronic pain after cardiac surgery is multifactorial and according to the authors with only one dose of pregabalin the patients in the pregabalin groups experienced less severe postoperative pain, used less analgesics, and reported less sleep disturbances without explaining which pain assessment tools they used and if the assessment was done at rest or at stress. Also, it is remarkable that many patients after cardiac surgery may have neuropathic pain characteristics, and it is appropriate to use not only chronic pain assessment tools but also neuropathic pain screening tools such as DN4 [6].

In our opinion, all these limitations may be responsible for their results. More studies and especially well-designed clinical trials are required in order to clarify the optimal dose, the duration of therapy, and the benefits and risks before adopting pregabalin in routine clinical practice and especially in patients undergoing cardiac surgery. Until then, the results may not be as ideal and promising as it sounds.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

References

  1. A. Bouzia, V. Tassoudis, M. Karanikolas et al., “Pregabalin Effect on Acute and Chronic Pain after Cardiac Surgery,” Anesthesiology Research and Practice, vol. 2017, Article ID 2753962, 7 pages, 2017. View at Publisher · View at Google Scholar · View at Scopus
  2. S. Bhojraj, R. D. Agaskar, S. J. Kapila, S. K. Patil, and A. A. Behranwala, “Effect of single dose preoperative pregabalin on postoperative pain after cardiac surgery,” Research and Innovation in Anesthesia, vol. 2, no. 1, pp. 4–8, 2017. View at Publisher · View at Google Scholar
  3. A. Pesonen, R. Suojaranta-Ylinen, E. Hammaren et al., “Pregabalin has an opioid-sparing effect in elderly patients after cardiac surgery: a randomized placebo-controlled trial,” British Journal of Anaesthesia, vol. 106, pp. 873–881, 2011. View at Publisher · View at Google Scholar · View at Scopus
  4. S. S. Joshi and A. M. Jagadeesh, “Efficacy of perioperative pregabalin in acute and chronic post-operative pain after off-pump coronary artery bypass surgery: a randomized, double-blind placebo controlled trial,” Annals of Cardiac Anaesthesia, vol. 16, no. 3, pp. 180–185, 2013. View at Publisher · View at Google Scholar · View at Scopus
  5. A. S. Sundar, R. Kodali, S. Sulaiman, R. Karthekeyan, M. Vakamudi, and H. Ravullapalli, “The effects of preemptive pregabalin on attenuation of stress response to endotracheal intubation and opioid-sparing effect in patients undergoing off-pump coronary artery bypass grafting,” Annals of Cardiac Anaesthesia, vol. 15, no. 1, pp. 18–25, 2012. View at Publisher · View at Google Scholar · View at Scopus
  6. P. N. Jain, “Oral pregabalin holds promise to reduce pain after cardiac surgery,” Annals of Cardiac Anaesthesia, vol. 16, no. 3, pp. 186-187, 2013. View at Google Scholar