Revista de la Sociedad Española del Dolor
versión impresa ISSN 1134-8046
ACIN, M.P. et al. Preventive analgesia with pregabalin in mesh hernia repair: Review at 1 year. Rev. Soc. Esp. Dolor [online]. 2009, vol.16, n.4, pp.215-221. ISSN 1134-8046.
Objective: Preventive analgesia consists of administrating drugs to achieve an analgesic state that decreases the peripheral and central sensory response to pain prior to surgical injury; thus, the aim is to break the cycle of inflammation-pain-hyperalgesia-increase of painful stimulus. Pregabalin is a neuro-regulator used in the treatment of neuropathic pain and several studies indicate that this drug can be administered to prevent postoperative pain symptoms. The aim of this study was to compare postoperative pain in patients undergoing open mesh hernia repair, treated either with or without pregabalin. Material and methods: A prospective randomized trial was conducted in 140 patients (112 men and 28 women) who underwent open inguinal, crural or umbilical hernia repair with mesh. Group I consisted of 70 patients treated with pregabalin 75 mg at night for 3 days before the intervention and 75 mg at night for 12 days after the procedure, including the day of surgery. Group II consisted of 70 patients not administered pregabalin. There were no differences between the two groups in age, which ranged between 18 and 79 years old (mean age 55.47 + 13.38), or in ASA grade (between I and III). Pain assessment was based on the visual analog scale (VAS) and pyrazolone consumption. The results were analyzed 1, 6, and 12 months after the intervention. Adverse effects, hours or sleep and quality of sleep were registered. The statistical analysis was performed using the Kolmogorov-Smirnov test with the Statgraphics program. P values of < 0.05 were considered statistically significant. Results: Analgesic results were as follows: group I: 1 month: good in 86%, medium in 14% and poor in 0%; 6 months: good in 89%, medium in 11% and poor in 0%; 12 months: good in 94%, medium in 6% and poor in 0%. Neuropathic pain occurred in 35% (75% pure and 25% mixed). Group II: 1 month: good in 56%, medium in 34% and poor in 10%; 6 months: good in 70%, medium in 22% and poor in 8%; 12 months: good in 83%, medium in 13% and poor in 4%. Neuropathic pain occurred in 85% (70% pure and 30% mixed). In both groups, pure nociceptive pain disappeared in the first 3-4 weeks. There was a statistically significant difference (p < 0.05) between the two distributions with a 95% confidence level; accordingly, the analgesic results showed statistically significant differences in distinct determinations in each group. In group I, hours of sleep increased in 56% of the patients and quality of sleep improved in 60%; these changes were not observed in group II. Adverse effects (10%) appeared only in group I (dizziness in five, drowsiness in one and migraine in one). Conclusions: Iatrogenic chronic neuropathic pain due to sensory nerve injury in open hernia repair is the most frequent cause of persistent postoperative pain. Preventive analgesia with pregabalin reduces the incidence of this pain. However, further studies are required to confirm this result.
Palabras clave : Preventive analgesia; Pregabalin; Mesh hernia repair.