Impact of Pregabalin in Chronic Users vs. a Perioperative Limited Prescription on Oxycodone Requirement
Condition: Postoperative Pain; Neuropathic Pain
MeSH terms: Neuralgia
Study type: Observational

Summary: 
      Spinal surgery is associated with intense pain and associated to a history of preoperative
      chronic pain. Pregabalin is licensed to treat chronic neuropathic pain, particularly when
      high dose of opioid are required. Preoperative pain is associated with high postoperative
      pain scores and opioid requirement promoting persistent hyperalgesic state. The investigators
      will evaluate the postoperative opioid consumption and pain scores in patients scheduled for
      lumbar surgery and taking pregabalin since more than 15 days and compare with preoperative
      pregabalin-free patient that will receive pregabalin only during surgery.
    

Detailed description: 
      Patients will be prospectively included and compared according their preoperative medication:
      pregabalin-treated patients (>more than 15 days) for neuropathic pain associated to spinal
      surgery and pregabalin-free patients for whom pregabalin will be prescribed for 48 hours.
      Patients will be included without randomization as an observational study. All the patients
      will receive multimodal analgesia and intraoperative management will be standardized. The
      main outcome will be the amount of oxycodone during the first 24h after surgery. Other
      outcomes include pain scores, the quantification of the neuropathic pain diagnostic
      questionnaire (DN4), nausea and vomiting, length of stay, side-effects of pregabalin and
      opioid. Patients were also evaluated at three months for pain scores and DN4 score.
      Postoperative evaluation will be performed in a single-blind manner with investigators not
      include in the recruitment or the peroperative period.
    

Intervention name(s): Pregabalin; Naive patient
Intervention type(s): Drug; Other
Intervention description(s): Pregabalin continued at the same preoperative dose 1h before surgery associated to paracetamol 1g PO and ketoprofen 100mg PO Intraoperative: nefopam 20mg IV + ketamine 0.3mg/kg IV + dexamethasone 8mg IV Postoperative: morphine titration in PACU (NRS > 3) + paracetamol 1g/6h PO + ketoprofen 100mg/12h PO systematically, oxycodone 5-10mg/12h PO if NRS>3; Pregabalin 150mg PO initiated 1h before surgery Associated to paracetamol 1g PO and ketoprofen 100mg PO Intraoperative: nefopam 20mg IV + ketamine 0.3mg/kg IV + dexamethasone 8mg IV Postoperative: morphine titration in PACU (NRS > 3) + paracetamol 1g/6h PO + ketoprofen 100mg/12h PO systematically, oxycodone 5-10mg/12h PO if NRS>3
Other intervention name(s): ATC code: N03AX16
Intervention MeSH terms: Pregabalin
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        The investigators will evaluate the postoperative opioid consumption and pain scores in
        patients scheduled for lumbar spine surgery and taking pregabalin since more than 15 days
        and compare with preoperative pregabalin-free patient that will receive pregabalin only
        during surgery.
      
Keywords: chronic pain; oxycodone; pregabalin; lumbar spine surgery; multimodal analgesia