Vaginal, laparoscopic, and robotic hysterectomies are minimally invasive procedures associated with better quality of life, shorter hospital stay, and lower complication rates than abdominal hysterectomies. However, they may be associated with severe postoperative pain.

A recent study performed a systematic review and meta-analysis of all randomized placebo-controlled trials (RCTs) that assessed the analgesic effects of preemptive Pregabalin among patients undergoing minimally invasive hysterectomy. It searched five major databases and evaluated relevant studies for risk of bias. 

Four studies with seven treatment arms met the inclusion criteria with a sample size of 304 patients. 193 and 111 patients received Pregabalin and placebo, respectively. Overall, the included studies revealed a low risk of bias. 

The results showed that the mean postoperative pain scores at rest were significantly lower in the pregabalin group than in the control group at 0, 2, 4, 6, 12, and 24 hours. Further, the mean postoperative pain scores on movement/coughing were also markedly lower in the pregabalin group than in the control group at 12 and 24 hours. The rate of opioid-free patients postoperatively was considerably higher in the pregabalin group than in the control group. The mean postoperative time to first rescue analgesic and the rates of adverse events were not significantly different between the groups. 

Thus, preemptive Pregabalin is safe and with superior analgesic effects in terms of lower postoperative pain scores and higher opioid-sparing effects compared with placebo. Additional RCTs are required to confirm these findings.

Source: Obstetrics & Gynecology Science 2022; 65(2): 133-144. DOI: https://doi.org/10.5468/ogs.21345