Pregabalin as an adjunct to a multimodal analgesic regimen to achieve opioid sparing in arthroscopic rotator cuff repair

Background: Arthroscopic rotator cuff repair of the shoulder is associated with a significant amount of pain, especially the first 36-48 postoperative hours [1]. Previous studies have demonstrated that an interscalene block is an effective analgesic technique for shoulder surgery [2-5]. However, even with the use of a long-acting local anesthetic, the analgesic effect of a single injection is limited to the first 6 to 12 hours [6]. Our objective was to determine the value of pregabalin as an opioid-sparing adjunct when used in combination with regional anesthesia techniques. Methods: We prospectively studied 50 patients undergoing primary arthroscopic rotator cuff repair under general anesthesia. Patients received a single-injection interscalene brachial plexus block with 30 mL of 0.5% ropivacaine, and oral celecoxib 200 mg and acetaminophen 500 mg. The patients were provided with a prescription for oral oxycodone 5 mg and acetaminophen 325 mg, 1-2 tablets every 4-6 hours as needed for postoperative supplemental analgesia. Patients were randomized to receive pregabalin (150 mg, twice daily, administered orally) or a placebo. The primary end point of the study was total opioid (oxycodone) consumption in the first 48 postoperative hours. Secondary end points included pain (evaluated with a 0-10 numeric rating scale anchored with 0 as .no pain. and 10 as .worst pain imaginable.), opioid- and pregabalin-related adverse effects, and duration of hospitalization. Results: Median opioid consumption during the first 48 postoperative hours was 51 mg (standard deviation [SD]: 40, interquartile range [IQR], 23-80 mg) in the pregabalin group and 64 mg (SD: 41, IQR: 35-90) in the placebo group (p = 0.26). Pain scores, adverse effects, and other secondary end points were similar between the groups. Conclusions: Pregabalin, at the dosage used in this study, resulted in a minimal or negligible decrease in opioid consumption when used as an adjunct to a multimodal, regional, analgesic regimen. The apparently lack of additive analgesia effect of pregabalin in this setting may be explained by the analgesic effects of the oral analgesics that were administered postoperatively. These nonsteroidal anti-inflammatory analgesics may have masked the pregabalin-induced analgesia by preventing postoperative central sensitization.