Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: Multimodal pain management strategies, including pregabalin (PGB) alone, have demonstrated efficacy in minimizing post-surgical pain and opioid use. Our study aimed to determine if a single pre-operative dose of PBG 150mg reduces post-operative pain and opioid requirements after orthotopic liver transplantation (OLT).
*Methods: This was a single center, retrospective, quasi-experimental, pre-post study. OLT recipients transplanted between 10/1/16 to 10/31/18 were included. Patients were excluded if they were on PGB or gabapentin prior to OLT. Patients ordered PGB were excluded if administration was not documented. Outcomes included the proportion of patients with no pain documented; proportion of patients with maximum level of pain documented as either mild, moderate or severe; and mean morphine milligram equivalents (MME) used within the first 24h and in the 24-72h following OLT. Numeric pain scale assessments and critical-care pain observational tool (CPOT) scores were used to assess pain in extubated and intubated patients, respectively. A CPOT score of >/=2 indicated a positive pain score and numeric pain scores were graded as mild (1-3), moderate (4-6), or severe (>/=7).
*Results: A total of 44 patients were evaluated in the PGB group vs. 57 in the standard of care (SOC) group. Baseline demographics were comparable in both groups. Patients in the PGB group were intubated longer and were less likely to have been on opioid pre-OLT than the SOC group, however this was not significant. In the first 24h post-OLT, there were numerically more patients with no documented pain, and fewer with severe pain in the PGB group, but these were not significant. A greater proportion of the PGB treated patients had a max mild pain score (p=0.039). Total opioid use was significantly reduced in the PGB group at both evaluated time points (both p <0.001), however no differences in pain scores were observed 24-72h post-OLT.
|PGB (n=44)||SOC (n=57)||p-value|
|No documented pain, n(%)||13(29.5)||12(21.5)||0.360|
|Max pain mild, n(%)||7(15.9)||2(3.5)||0.039|
|Max pain moderate, n(%)||4(9.1)||6(10.5)||1.000|
|Max pain severe, n(%)||16(36.4)||30(52.6)||0.113|
|CPOT ≥2, n(%)||11(25.0)||19(33.3)||0.389|
|Mean MME used, mg ±SD||8.7±11.7||28.9±29.5||<0.001|
*Conclusions: This small study did not show that a single dose of pre-operative PGB reduced overall pain scores after OLT. However, more patients reported a max of mild pain and total opioid utilization was lower in patients who received PGB. Larger studies will help determine the efficacy of PGB in this setting.
To cite this abstract in AMA style:Knorr JP, Barlow A, Reinaker T, Zaki R. Single-Dose Pre-Operative Pregabalin to Minimize Pain and Opioid Use after Liver Transplantation [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/single-dose-pre-operative-pregabalin-to-minimize-pain-and-opioid-use-after-liver-transplantation/. Accessed October 22, 2020.
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