Effectiveness of combined Pregabalin and Celecoxib for treatment of neuropathic pain after percutaneous endoscopic lumbar discectomy_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIZhuhai ^1,2 ,  ZENGJiancheng ¹ , NIEHongfei ¹ , JIANGHushan ¹ , XIETianhang ¹ , SONGYueming ¹

1. Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;
2. Department of Orthopedics, the People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning Guangxi, 530021, P.R.China;

Corresponding author：

ZENGJiancheng, Email: tomzeng5@163.com

Keywords：

Lumbar disc herniation; neuropathic pain; Pregabalin; Celecoxib

DOI：

10.7507/1002-1892.201609084

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Objective To investigate the effectiveness of combined Pregabalin and Celecoxib for neuropathic pain after percutaneous endoscopic lumbar discectomy. Methods Between January and June 2014, 178 patients with lumbar disc herniation underwent percutaneous endoscopic interlaminar discectomy (PEID). Ninety patients who met the inclusion criteria were recruited in this study. Every case in group A was recruited to match its counterpart in group B and group C according to gender, disease duration, herniated level, smoking history, preoperative Leeds assessment of neuropathic symptoms and signs (LANSS), and Oswestry disability index (ODI). Nine patients were excluded due to incomplete study or loss of follow-up. In each group, 27 cases were included in the final analysis. There was no significant difference in gender, age, height, body mass index, herniated level, disease duration, smoking history, preoperative LANSS, ODI, and visual analogue scale (VAS) between groups (P>0.05). All patients of 3 groups received oral administration of Celecoxib from preoperative 3rd day to postoperative 14th day. Pregabalin was taken orally from preoperative 3rd day to postoperative 14th day in group A, and from postoperative 1st to 14th day in group B. Adverse drug reactions were observed during medication. The LANSS score and VAS score in rest state and active state were conducted before operation and at 1 day, 1 month, and 3 months after operation. ODI was conducted before operation and at 1, 3 months after operation. The number of neuropathic pain cases was recorded, and the effectiveness was evaluated by modified Macnab criteria at 3 months after operation. Results During period of increasing Pregabalin dose, 1 patient of group A suffered severe dizziness, and 1 patient of group B suffered sleepiness, who were eliminated from this research. Another 2 cases (1 case of group A and 1 case of group C) suffered dry mouth, and 1 case of group B suffered muscle weakness. At 1 day after operation, the LANSS score and VAS in rest state and active state of group A were significantly lower than those of groups B and C (P<0.05). At 1 month after operation, the LANSS score, ODI, and VAS in rest state and active state of group A and group B were significantly lower than those of group C (P<0.05). At 3 months after operation, the LANSS score, ODI, and VAS in active state of group A and group B were significantly lower than those of group C (P<0.05). There was no significant difference in the above indicators at the other time points between groups (P>0.05). Neuropathic pain occurred at 3 months after operation in 1 case (3.7%) of group A and 6 cases (22.2%) of group C, showing significant differences in incidence of neuropathy pain between groups A, B and group C (P<0.05), but no significant difference was found between group A and group B (P>0.05). The excellent and good rate of modified Macnab criteria was 92.6% in group A, was 88.9% in group B, and was 85.2% in group C at 3 months after operation, showing no significant difference between groups (P>0.05). Conclusion Combined use of Pregabalin and Celecoxib during perioperative period can reduce postoperative pain and incidence of postoperative neuropathic pain. Preoperative oral Pregabalin can reduce the incidence of acute postoperative neuropathic pain.

Citation： LIZhuhai, ZENGJiancheng, NIEHongfei, JIANGHushan, XIETianhang, SONGYueming. Effectiveness of combined Pregabalin and Celecoxib for treatment of neuropathic pain after percutaneous endoscopic lumbar discectomy. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(2): 215-221. doi: 10.7507/1002-1892.201609084 Copy

1.	Atlas SJ, Keller RB, Wu YA,et al. Long-term outcomes of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: 10 year results from the maine lumbar spine study. Spine (Phila Pa 1976), 2005, 30(8): 927-935.
2.	Burke SM, Shorten GD. Perioperative pregabalin improves pain and functional outcomes 3 months after lumbar discectomy. Anesth Analg, 2010, 110(4): 1180-1185.
3.	Woolf CJ, Bennett GJ, Doherty M,et al. Towards a mechanism-based classification of pain? Pain, 1998, 77(3): 227-229.
4.	Jensen TS, Baron R, Haanpää M,et al. A new definition of neuropathic pain. Pain, 2011, 152(10): 2204-2205.
5.	Dolgun H, Turkoglu E, Kertmen H,et al. Gabapentin versus pregabalin in relieving early post-surgical neuropathic pain in patients after lumbar disc herniation surgery: a prospective clinical trial. Neurol Res, 2014, 36(12): 1080-1085.
6.	Apfelbaum JL, Chen C, Mehta SS,et al. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg, 2003, 97(2): 534-540.
7.	Shaladi AM, Saltari MR, Crestani F,et al. Post-surgical neuropathic pain. Recenti Prog Med, 2009, 100(7-8): 371-379.
8.	Gajraj NM. Pregabalin: its pharmacology and use in pain management. Anesth Analg, 2007, 105(6): 1805-1815.
9.	Gianesello L, Pavoni V, Barboni E,et al. Perioperative pregabalin for postoperative pain control and quality of life after major spinal surgery. J Neurosurg Anesthesiol, 2012, 24(2): 121-126.
10.	Moore RA, Straube S, Wiffen PJ,et al. Pregabalin for acute and chronic pain in adults. Cochrane Database Syst Rev, 2009, (3): CD007076.
11.	Clarke H, Bonin RP, Orser BA,et al. The prevention of chronic postsurgical pain using gabapentin and pregabalin: a combined systematic review and meta-analysis. Anesth Analg, 2012, 115(2): 428-442.
12.	Kumar KP, Kulkarni DK, Gurajala I,et al. Pregabalin versus tramadol for postoperative pain management in patients undergoing lumbar laminectomy: a randomized, double-blinded, placebo-controlled study. J Pain Res, 2013, 6: 471-478.
13.	Spreng UJ, Dahl V, Raeder J. Effect of a single dose of pregabalin on post-operative pain and pre-operative anxiety in patients undergoing discectomy. Acta Anaesthesiol Scand, 2011, 55(5): 571-576.
14.	Buvanendran A, Kroin JS, Della Valle CJ,et al. Perioperative oral pregabalin reduces chronic pain after total knee arthroplasty: a prospective, randomized, controlled trial. Anesth Analg, 2010, 110(1): 199-207.
15.	Kim JC, Choi YS, Kim KN,et al. Effective dose of peri-operative oral pregabalin as an adjunct to multimodal analgesic regimen in lumbar spinal fusion surgery. Spine (Phila Pa 1976), 2011, 36(6): 428-433.
16.	Reuben SS, Buvanendran A, Kroin JS,et al. The analgesic efficacy of celecoxib, pregabalin, and their combination for spinal fusion surgery. Anesth Analg, 2006, 103(5): 1271-1277.
17.	Bennett MI, Attal N, Backonja MM,et al. Using screening tools to identify neuropathic pain. Pain, 2007, 127(3): 199-203.
18.	Khedr EM, Kotb H, Kamel NF,et al. Longlasting antalgic effects of daily sessions of repetitive transcranial magnetic stimulation in central and peripheral neuropathic pain. J Neurol Neurosurg Psychiatry, 2005, 76(6): 833-838.

1. Atlas SJ, Keller RB, Wu YA,et al. Long-term outcomes of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: 10 year results from the maine lumbar spine study. Spine (Phila Pa 1976), 2005, 30(8): 927-935.
2. Burke SM, Shorten GD. Perioperative pregabalin improves pain and functional outcomes 3 months after lumbar discectomy. Anesth Analg, 2010, 110(4): 1180-1185.
3. Woolf CJ, Bennett GJ, Doherty M,et al. Towards a mechanism-based classification of pain? Pain, 1998, 77(3): 227-229.
4. Jensen TS, Baron R, Haanpää M,et al. A new definition of neuropathic pain. Pain, 2011, 152(10): 2204-2205.
5. Dolgun H, Turkoglu E, Kertmen H,et al. Gabapentin versus pregabalin in relieving early post-surgical neuropathic pain in patients after lumbar disc herniation surgery: a prospective clinical trial. Neurol Res, 2014, 36(12): 1080-1085.
6. Apfelbaum JL, Chen C, Mehta SS,et al. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg, 2003, 97(2): 534-540.
7. Shaladi AM, Saltari MR, Crestani F,et al. Post-surgical neuropathic pain. Recenti Prog Med, 2009, 100(7-8): 371-379.
8. Gajraj NM. Pregabalin: its pharmacology and use in pain management. Anesth Analg, 2007, 105(6): 1805-1815.
9. Gianesello L, Pavoni V, Barboni E,et al. Perioperative pregabalin for postoperative pain control and quality of life after major spinal surgery. J Neurosurg Anesthesiol, 2012, 24(2): 121-126.
10. Moore RA, Straube S, Wiffen PJ,et al. Pregabalin for acute and chronic pain in adults. Cochrane Database Syst Rev, 2009, (3): CD007076.
11. Clarke H, Bonin RP, Orser BA,et al. The prevention of chronic postsurgical pain using gabapentin and pregabalin: a combined systematic review and meta-analysis. Anesth Analg, 2012, 115(2): 428-442.
12. Kumar KP, Kulkarni DK, Gurajala I,et al. Pregabalin versus tramadol for postoperative pain management in patients undergoing lumbar laminectomy: a randomized, double-blinded, placebo-controlled study. J Pain Res, 2013, 6: 471-478.
13. Spreng UJ, Dahl V, Raeder J. Effect of a single dose of pregabalin on post-operative pain and pre-operative anxiety in patients undergoing discectomy. Acta Anaesthesiol Scand, 2011, 55(5): 571-576.
14. Buvanendran A, Kroin JS, Della Valle CJ,et al. Perioperative oral pregabalin reduces chronic pain after total knee arthroplasty: a prospective, randomized, controlled trial. Anesth Analg, 2010, 110(1): 199-207.
15. Kim JC, Choi YS, Kim KN,et al. Effective dose of peri-operative oral pregabalin as an adjunct to multimodal analgesic regimen in lumbar spinal fusion surgery. Spine (Phila Pa 1976), 2011, 36(6): 428-433.
16. Reuben SS, Buvanendran A, Kroin JS,et al. The analgesic efficacy of celecoxib, pregabalin, and their combination for spinal fusion surgery. Anesth Analg, 2006, 103(5): 1271-1277.
17. Bennett MI, Attal N, Backonja MM,et al. Using screening tools to identify neuropathic pain. Pain, 2007, 127(3): 199-203.
18. Khedr EM, Kotb H, Kamel NF,et al. Longlasting antalgic effects of daily sessions of repetitive transcranial magnetic stimulation in central and peripheral neuropathic pain. J Neurol Neurosurg Psychiatry, 2005, 76(6): 833-838.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of combined Pregabalin and Celecoxib for treatment of neuropathic pain after percutaneous endoscopic lumbar discectomy

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