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Perioperative Pregabalin Reduces Neuropathic Pain at 6 months after TKA

Perioperative Pregabalin Reduces Neuropathic Pain at 6 months after TKA. Asokumar Buvanendran, MD Associate Professor Director of Orthopedic Anesthesia Department of Anesthesiology Rush University Medical College Chicago, IL. Co-Investigators: J. Kroin, PhD

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Perioperative Pregabalin Reduces Neuropathic Pain at 6 months after TKA

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  1. Perioperative Pregabalin Reduces Neuropathic Pain at 6 months after TKA Asokumar Buvanendran, MD Associate Professor Director of Orthopedic Anesthesia Department of Anesthesiology Rush University Medical College Chicago, IL

  2. Co-Investigators: J. Kroin, PhD C. Dellavalle, MD (orthopedic surgery) M. Kari, MD M. Moric, PhD K. Tuman, MD Medical school grant from Pfizer

  3. Mechanism of Analgesia • Gabapentin and Pregabalin bind to the alpha-2-delta sub-unit of the N-type voltage gated calcium channel • Same mechanism of action whether it is neuropathic pain or inflammatory pain (post-surgical) • This binding results in ↓ release of • Substance P, Calcitonin Gene-related peptide • Glutamate • It has been approved for Neuropathic pain conditions and recently for Fibromyalgia

  4. Chronic Neuropathic Pain From Orthopedic Surgery

  5. Consequence of Orthopedic Surgery: Chronic Pain Syndromes Knee Scope Post TKR

  6. RCT: Study Design (Level 1) • 240 Patients randomized into 2 groups: • Preop pregabalin 300 mg + Postop 150 mg BID for 10 days and then 75 mg BID and titrated to 50 mg and stopped on day #14 • Preop Placebo + Postop Placebo • Standard surgery and anesthesia • Anesthesia: • Combined spinal epidural

  7. RCT: Study Design (Level 1) • Outcomes: • Chronic Neuropathic pain at: • Telephone Interview of these patients • 1, 3 and 6 moths postop • Follow-up data: • 113 patients for Pregabalin • 115 patients for Placebo

  8. S-LANSS Pain Score:  12 points is neuropathic pain

  9. Demographics

  10. Neuropathic Pain from TKA * *

  11. Allodynia or Hyperalgesia of Knee * *

  12. Knee Injury Osteoarthritis Outcome Score (KOOS) • In patients with neuropathic pain the KOOS at 6 months: • Neuropathic pain: 49.0 16.2 (placebo pat) • No Neuropathic pain: 25.7  7.8 (placebo pat) • No Neuropathic pain: 12.4  5.5 (pregabalin pat)

  13. Conclusion • The perioperative administration of pregabalin for TKA patients can lead to: • ↓ incidence of Chronic Neuropathic pain • ↑ Quality of life for patients that developed chronic pain

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