Comparative efficacious study between preoperative pregabalin and gabapentin on postoperative pain in abdominal hysterectomy: an institutional experience

Gayathri K. B., Prem Swaroop V., Sajana G., . Uday, Bhargav P. R. K.


Background: Pain is a consistent and predominant complaint following surgical intervention including abdominal open hysterectomy. A multimodal approach has been suggested to improve postoperative analgesia and to reduce opioid related side effects. In this context we conducted a comparative study on efficacy between gabapentin and pregabalin on postoperative pain relief.

Methods: In this prospective randomised study, 60 patients were divided in to two arms group G and group P. 900 mg of gabapentin and 300 mg of pregabalin were administered orally one hour before spinal anaesthesia to respective groups. Hemodynamic parameters such as heart rate, mean arterial pressure, respiratory rate was monitored pre, per and postoperatively. Also, the need for first analgesic dose and visual analog pain score were documented in all subjects of both groups. Statistical analysis with SPSS 16.0 performed.

Results: There was significant fall in mean arterial pressure in group G than group P patients. Further the fall in mean pulse rate was more in group G compared to group P throughout pre, per and post-operative phases. In terms of mean postoperative time required for first dose of analgesic drug, pregabalin and gabapentin was required after 7 and 5 hours respectively. There was a statistically significant change in Visual Analogue Scale, showing pregabalin as better drug than gabapentin in post operative pain control with score 5 and 7 respectively.

Conclusions: Pre-emptive analgesia with pregabalin appears to be superior to gabapentin as a part of multimodal perioperative pain management in abdominal hysterectomy.


Gabapentin, Hysterectomy, NSAIDS, Opioids, Pain, Pregabalin

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James D, Justins D. Acute post-operative pain. In: Healy TE, Knight PR, eds. Wylie and Churchill Davidson's A practice of Anaesthesia. 7th ed. London: Arnold Publishers; 2003: 1213-34.

Turan A, Karamanlioglu B, Memis D, Hamamcıoglu MK, Tükenmez B, Pamukçu Z et al. Analgesic effects of gabapentin after spinal surgery. Anesthesiology. 2004;100:935-8.

Woolf CJ, Chong MS. Preemptive analgesia–Treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg. 1993;77:362-79.

Woolf CJ, Salter MW. Neuronal plasticity: increasing the gain in pain. Science. 2000;288:1765-69.

Costigan M, Scholz J, Woolf CJ. Neuropathic pain: a maladaptive response of the nervous system to damage. Annu Rev Neurosci. 2009;32:1-32.

Fitzgerald M. The development of nociceptive circuits. Nat Rev Neurosci. 2005;6:507-20.

Latremoliere A, Woolf CJ. Central sensitization: a generator of pain hypersensitivity by central neural plasticity. J Pain. 2009;10: 895-926.

Woolf CJ, Ma Q. Nociceptors--noxious stimulus detectors. Neuron. 2007;55:353-64.

Joshi GP. Multimodal analgesia techniques and postoperative rehabilitation. Anesthesiol Clin North America. 2005;23:185-202.

Taylor CP. Mechanisms of analgesia by gabapentin and pregabalin- calcium channel alpha2-delta [Cavalpha2-delta] ligands. Pain. 2009;142:13-16.

Field MJ, Cox PJ, Stott E, Melrose H, Offord J, Su TZ etal. Identification of the alpha2-delta-1 subunit of voltage-dependent calcium channels as a molecular target for pain mediating the analgesic actions of pregabalin. Proceedings of the National Academy of Sciences of the U.S.A. 2006;103:17537-42.

Taylor CP, Angelotti T, Fauman E. Pharmacology and mechanism of action of pregabalin: The calcium channel alpha(2)-delta (alpha(2)-delta) subunit as a target for antiepileptic drug discovery. Epilepsy Res. 2007;73:137-50.

Sze PY. L-Glutamate decarboxylase. Adv Experiment Med Biol. 1979;123:59-78.

Ankesh K, Bali A. Implications and mechanism of action of gabapentin in neuropathic pain. Arch Pharmacal Res. 2013;36:237-251.

Stewart BH, Kugler AR, Thompson PR, Bockbrader HN. A saturable transport mechanism in the intestinal absorption of gabapentin is the underlying cause of the lack of proportionality between increasing dose and drug levels in plasma. Pharmaceut Res. 1993;10:276-81.

Bockbrader HN, Wesche D, Miller R, Chapel S, Janiczek N, Burger P. A comparison of the pharmacokinetics and pharmacodynamics of pregabalin and gabapentin. Clin Pharmacokinetics. 2010;49:661-9.

Bryans, Justin S, Wustrow, David J. 3-Substituted GABA analogs with central nervous system activity: A review". Med Res Rev. 1999;19:149-77.

Lauria-Horner BA, Pohl RB. Pregabalin: a new anxiolytic. Expert Opinion on Investigational Drugs. 2003;12:663-72.

O'Brien C. Drug addiction and drug abuse. In: Brunton LB, Lazo JS, Parker KL, eds. Goodman and Gilman's The Pharmacological Basis of Therapeutics. 11th ed. New York, NY: McGraw-Hill; 2005:607-629.

McMahon, Stephen B. Wall and Melzack's textbook of pain. 6th ed. Philadelphia, PA: Elsevier/Saunders; 2013:515.

Ghai A, Gupta M, Hooda S, Singla D, Wadhera R. A randomized controlled trial to compare pregabalin with gabapentin for postoperative pain in abdominal hysterectomy. Saudi J Anaesthesia. 2011 Jul;5(3):252-7.

Paech MJ, Gay R, Chua S, Scott K, Christmas T, Doherty DA. A randomized, placebo-controlled trial of preoperative pregabalin for postoperative pain relief after minor gynaecological surgery. Anesth Analg. 2007;105:1449-53.