Effect of esketamine combined with pregabalin on acute postsurgical pain in patients who underwent resection of spinal neoplasms: a randomized controlled trial.
Yang Zhou, Wanchen Sun, Yuxuan Fu, Jing Wang, Jingyi Fan, Yuchao Liang, Wenqing Jia, Ruquan Han
Pain September 1, 2024 DOI: 10.1097/j.pain.0000000000003211 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 90 |
| Population | Patients aged 18 to 65 years undergoing resection of spinal neoplasms |
| Interventions | Esketamine Pregabalin |
| Dose | esketamine: a bolus dose of 0.5 mg·kg -1 and an infusion dose of 0.12 mg·kg -1 ·h -1 for 48 hours after surgery; oral pregabalin: 75-150 mg/day, starting 2 hours before surgery and ending at 2 weeks after surgery |
| Duration | 48-hour intervention for esketamine, 2-week pregabalin course starting 2 hours before surgery |
| Topics | Esketamine |
| Keywords | Pain-management Spine-surgery Clinical-research Anesthesia Drug-therapy |
| Citations | 9 |
| Key findings | Esketamine combined with pregabalin reduced the incidence of moderate-to-severe acute postsurgical pain after spinal surgery but increased the risk of mild dissociative symptoms. |
Abstract
Moderate-to-severe acute postsurgical pain (APSP) can prolong the recovery and worsen the prognosis of patients who undergo spinal surgery. Esketamine and pregabalin may resolve APSP without causing hyperpathia or respiratory depression after surgery. However, there are other risks, such as dissociative symptoms. We designed a randomized controlled trial to investigate the effect of the combination of these 2 drugs on the incidence of APSP in patients who underwent resection of spinal neoplasms. Patients aged 18 to 65 years were randomized to receive esketamine (a bolus dose of 0.5 mg·kg -1 and an infusion dose of 0.12 mg·kg -1 ·h -1 for 48 hours after surgery) combined with oral pregabalin (75-150 mg/day, starting 2 hours before surgery and ending at 2 weeks after surgery) or an identical volume of normal saline and placebo capsules. The primary outcome was the proportion of patients with moderate-to-severe APSP (visual analog scale score ≥ 40) during the first 48 hours after surgery. Secondary outcomes included the incidence of drug-related adverse events. A total of 90 patients were randomized. The incidence of moderate-to-severe APSP in the combined group (27.3%) was lower than that in the control group (60.5%) during the first 48 hours after surgery (odds ratio = 0.25, 95% CI = 0.10-0.61; P = 0.002). The occurrence of mild dissociative symptoms was higher in the combined group than in the control group (18.2% vs 0%). In conclusion, esketamine combined with pregabalin could effectively alleviate APSP after spinal surgery, but an analgesic strategy might increase the risk of mild dissociative symptoms.