2008 Annual Meeting Abstracts

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Multimodal Analgesic Therapy with Pre-operative Pregabalin Reduces Opioid Use in Patients Undergoing Robotic Prostatectomy
Jitesh V Patel¹, Costas D Lallas¹, Salvador F Iloreta*¹, Eugene Viscusi*², Leonard G Gomella¹, Edouard J Trabulsi^1
1Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA;²Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, PA

INTRODUCTION
Minimally invasive surgical techniques have many benefits, including reduced post-operative pain. Despite this, the majority of patients require opioid analgesia, which can have significant side effects and toxicity. We report the first urologic study using multimodal analgesia with pregabalin, a gabapentin derivative.
METHODS
This retrospective IRB approved study included 52 patients undergoing robotic assisted laparoscopic radical prostatectomy (RALP). All patients received a standard post-operative analgesic regimen with intravenous ketorolac 15 mg every 6 hours with oxycodone 5 mg/ acetaminophen 325 mg, one to two tablets every four hours as needed for pain. Twenty six patients received additional multimodal treatment with pregabalin 150mg, acetaminophen 975mg, and celecoxib 400mg PO two hours prior to the start of the procedure and continued post-operatively.
RESULTS
Patients in the multimodal treatment group had a significantly reduced intra-operative opioid requirement, as measured by mean morphine equivalent dose administered (38.4 mg vs. 49.1 mg , p <0.01). The mean post-operative opioid use was also significantly reduced (10.7 mg vs 26.2 mg, p=0.034).
The operative time, estimated operative blood loss, antiemetic use, post operative creatinine and hemoglobin, and length of stay were similar in both groups. There were no operative or treatment complications in either group.
CONCLUSIONS
This retrospective review indicates that a multimodal analgesic approach with pregabalin decreases intra-operative and post-operative opioid use in patients undergoing RALP. A larger prospective study is necessary to fully evaluate the benefits of a multimodal approach, including quality of pain control and opioid related side effects.

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