Perioperative Pregabalin for Preventive Analgesia in Breast Cancer Surgery: A Meta-analysis of Randomized Controlled Trials.

OBJECTIVES Pregabalin is a drug for neuropathic pain. The antipronociceptive properties of pregabalin have led to its recent use as an adjuvant to the multimodal postoperative pain regimen. This meta-analysis was conducted to evaluate the efficacy of perioperative pregabalin on acute and chronic postsurgical pain(CPSP) after breast cancer surgery. METHODS A meta-analysis including eight randomized controlled trials searched from MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials was conducted. Subgroup analysis was performed according to doses and time-course of pregabalin administration. Review Manager 5.3 was selected to conduct the meta-analysis. RESULTS Preoperative pregabalin in breast cancer surgery alleviated acute postoperative pain at rest 24 hours after surgery by 0.31 points on an 0-10 Numeric Rating Scale (NRS) (95% CI -0.57 to -0.05). Morphine consumption showed a decrease in postoperative use by 1.09▒mg (95% CI -1.61 to -0.57). The incidence of CPSP 3 months after surgery was reduced to 46% (95% CI 0.25 to 0.85). Postoperative nausea and vomiting (PONV), dizziness, and sedation showed no overall significant reductions. However, a decrease in incidence of PONV and an increase in incidence of dizziness were noted when patients received 300▒mg of pregabalin before surgery. DISCUSSION This study demonstrated that pregabalin showed more efficacy on chronic pain than acute pain after a breast cancer surgery. Further study based on doses and treatment course of pregabalin should be conducted to establish stronger evidences of treatment effects.