Efficacy and safety of perioperative pregabalin for post-operative pain: a meta-analysis of randomized-controlled trials

We calculated in a meta-analysis the effect size for the reduction of post-operative pain and post-operative analgesic drugs, which can be obtained by the perioperative administration of pregabalin. Three end-points of efficacy were analysed: early (6 h-7 days) post-operative pain at rest (17 studies) and during movement (seven studies), and the amount of analgesic drugs in the studies that obtained identical results for pain at rest (12 studies). Reported adverse effects were also analysed. The daily dose of pregabalin ranged from 50 to 750 mg/day. The duration of treatment in patients assessed for pain ranged from a single administration to 2 weeks. Pregabalin administration reduced the amount of post-operative analgesic drugs (30.8% of non-overlapping values - odds ratio = 0.43). There was no effect with 150, and 300 or 600 mg/day provided identical results. Pregabalin increased the risk of dizziness or light-headedness and of visual disturbances, and decreased the occurrence of postoperative nausea and vomiting (PONV) in patients who did not receive anti-PONV prophylaxis. The administration of pregabalin during a short perioperative period provides additional analgesia in the short term, but at the cost of additional adverse effects. The lowest effective dose was 225-300 mg/day.