Effects of Perioperative Pregabalin for Post-Craniotomy Pain
Study Details
Study Description
Brief Summary
Objective: To compare the incidence of chronic pain at 3 months among adults undergoing craniotomy between those received two different doses of pregabalin and those receiving placebo.
Condition or Disease | Intervention/Treatment | Phase |
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Phase 4 |
Detailed Description
Hypothesis: Perioperative pregabalin will reduce the incidence of chronic post-operative pain, and will reduce the opioid consumption, opioid-related side effects, and hospital length of stay compared with placebo in patients undergoing elective craniotomy.
Methods: 316 adults (18-65y), ASA I-III, undergoing elective craniotomy will be randomized to receive: 100mg or 150mg pregabalin or placebo once pre-operatively and 50mg or 75mg or placebo twice daily for 14 post-operative days. NRS pain scores, opioid consumption and side effects will be assessed up to 48h, and long-term pain at days 7, 14, 30, and 90. The primary analysis will involve the comparison between the 2 treatment groups together vs. placebo. A stepwise method will be used to evaluate the pairwise comparisons.
Outcomes: The primary outcome will be the incidence of chronic post-craniotomy pain at 3 mos. Important secondary outcomes are: neuropathic component of pain at 3 mos., total opioid consumption in the first 24h, and incidence and severity of opioid-related side effects at days 1, 2 and 7.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Experimental: Pregabalin 100 mg
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Drug: Pregabalin
Pre-operatively, one of the 2 doses of pregabalin (100 or 150 mg) or placebo will be given to patients 1 hour before the surgery. Post-operatively, patients will receive daily (split in 2 equal doses) pregabalin 100 mg, pregabalin 150 mg, or placebo for the first 14 post-operative days.
Other Names:
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Experimental: pregabalin 150 mg
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Drug: pregabalin
Pre-operatively, one of the 2 doses of pregabalin (100 or 150 mg) or placebo will be given to patients 1 hour before the surgery. Post-operatively, patients will receive daily (split in 2 equal doses) pregabalin 100 mg, pregabalin 150 mg, or placebo for the first 14 post-operative days.
Other Names:
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Sham Comparator: Placebo
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Drug: placebo
Identical placebo capsules will be administered in the same way.
Other Names:
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Outcome Measures
Primary Outcome Measures
- Chronic post-craniotomy pain [3 months]
The primary outcome of this study will be the incidence of chronic post-craniotomy pain at 3 months
Secondary Outcome Measures
- neuropathic component of the pain at 3 months [3 months]
- incidence of long-term pain at days 7 [Day 7]
- incidence of long-term pain at day 14 [Day 14]
- incidence of long-term pain at day 30 [Day 30]
- total opioid consumption in the first 24h [24 hours]
- total patient-controlled analgesia (PCA)demands and delivered doses in 24h [24 hours]
- post-operative pain scores at 24h [24 hours]
- post-operative pain scores at 48h [48 hours]
- incidence and severity of opioid-related side effects at day 2 [Day 2]
- incidence and severity of opioid-related side effects at Day 7 [Day 7]
- consumption of antiemetics in the first 24h [24 hours]
- tracheal extubation time [within 24 hours]
- length of hospital stay [30 days]
Eligibility Criteria
Criteria
Inclusion Criteria:
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Adults, 18 to 65 years (limited to 65 years to lower the risk of over-sedation for elderly patients)
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Undergoing elective craniotomy (supratentorial or infratentorial) under general anaesthesia for: biopsy or resection of a tumour, clipping of an unruptured aneurysm, or excision of an arteriovenous malformation
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ASA physical status I-III
Exclusion Criteria:
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predicted need for prolonged post-operative ventilation (> 12 hours)
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chronic pain secondary to previous craniotomy
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known adverse reaction to drugs used (gabapentin, pregabalin, hydromorphone, and/or acetaminophen)
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prior use of pregabalin or gabapentin (within 2 weeks before surgery)
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current history of moderate to severe headaches (NRS ≥ 4) related to intracranial pathology (tumour pain) since it may be difficult to discriminate between ongoing tumour pain and surgery-related post-operative pain
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current history of migraines
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pre-existing chronic pain requiring chronic opioid use (30mg morphine equivalent within 4 weeks of surgery)
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currently taking any drug that could interact with pregabalin
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current history of alcohol or recreational drug abuse
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known or suspected addiction to narcotic substances or chronic narcotic use in the last 2 weeks
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history of malignant hyperthermia (contraindicates the anaesthesia protocol of this study)
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history of angioedema
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Body Mass Index ≤ 18.4 or ≥ 35
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history of untreated obstructive sleep apnea
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any condition that would contraindicate the use of patient-controlled analgesia (PCA)
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lacks fluency in English
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pre-existing renal impairment (for pregabalin elimination)
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pregnancy
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | St. Michael's Hospital | Toronto | Ontario | Canada | M5B 1W8 |
Sponsors and Collaborators
- Unity Health Toronto
Investigators
- Principal Investigator: Andrea Rigamonti, MD, Unity Health Toronto
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- REB-10-388