Effect of preoperative pregabalin on post-caesarean delivery analgesia: a dose-response study

•We examined the efficacy and safety of pregabalin before caesarean delivery.•Pregabalin 300 mg reduces postoperative morphine consumption, nausea, vomiting and pruritus.•Over 30% of mothers experienced visual disturbances.•Neonatal outcome was comparable with either pregabalin 150 mg or 300 mg.

IntroductionWe hypothesised that preoperative administration of a single-dose of pregabalin would be associated with lower morphine consumption after uncomplicated caesarean delivery.MethodsAfter Institutional Ethics Committee approval, 135 parturients scheduled for elective caesarean delivery under spinal anaesthesia were randomly allocated to receive either placebo, or oral pregabalin 150 mg or 300 mg, one hour before induction of anaesthesia. Maternal cumulative morphine requirement at 24 h, pain scores, sedation scores, nausea and vomiting, pruritus, pregabalin-related adverse effects, Apgar scores, Neurologic and Adaptive Capacity scores and umbilical cord acid-base status were recorded.ResultsCompared with placebo or pregabalin 150 mg, the use of a preoperative dose of pregabalin 300 mg resulted in significantly lower cumulative morphine consumption at 24 h (mean dose: placebo 12.9 mg [95% CI 11.6 to 14.2]; pregabalin 150 mg 11.9 mg; [95% CI 10.7 to 13.1]; pregabalin 300 mg 6 mg [95% CI 5.4 to 7.3]; P<0.001). Pregabalin 300 mg resulted in lower pain scores at 4 h and 6 h after delivery (P<0.001), and fewer instances of nausea, vomiting and pruritus (P<0.009). Dizziness and abnormal vision were observed most frequently in the pregabalin 300 mg group (P<0.05 and P<0.009, respectively). The three groups were similar in terms of maternal sedation, Apgar scores, Neurologic and Adaptive Capacity scores and umbilical cord acid-base status. Three babies in the pregabalin 300 mg group (6.7%) experienced short-term poor latching-on for breastfeeding.ConclusionIn our study, preoperative administration of pregabalin 300 mg reduced postoperative morphine consumption and early postoperative pain in parturients undergoing elective caesarean delivery, although maternal side effects were more common.