Pre-emptive Pain Regimen Cuts Down Post-Operative Opioid Use

Administering a multimodal pain regimen that includes pregablin (Lyrica) prior to robotic-assisted laproscopic radical prostatectomy decreased a patients’ use of opioid analgesics afterward, according to researchers from the Thomas Jefferson University.

The report was published in the journal Urology and found that compared to patients that did not receive the pre-emptive multimodal regimen, the patients that did receive it used significantly less narcotic pain medications during post-operative analgesic treatment. Those that received the pre-emptive treatment also did not report any additional side effects.

"This is the first demonstration of the effectiveness of a pre-emptive pain management protocol using pregabalin in urologic surgery," said Edouard J. Trabulsi, M.D., associate professor of Urology at Jefferson Medical College of Thomas Jefferson University, in a press release. "We think this study paves the way for new pain management protocols. Though a larger prospective study is necessary to accurately characterize the benefit of reducing opioids, it could have significant implications not only for robotic prostatectomy, but also other laparoscopic procedures and more painful surgeries."

Trabulsi and team conducted a retrospective study that included 60 patients undergoing robotic prostatectomy. Thirty of the patients received the multimodal pre-operative treatment and 30 previous patients received only the standard postoperative analgesic regimen.

Those in the pre-operative treatment group received pregabalin, acetaminophen and celecoxib, orally, two hours before the procedure and continued postoperatively in combination with intravenous ketorolac. Those in the standard postoperative analgesic regimen group received intravenous ketorolac, without pregabalin or celecoxib. All of the patients received oxycodone on an as needed basis.