Is pregabalin addition to infraclavicular block, effective in distal radius surgery?

Abstract

Objective: Our study evaluated the effects of pregabalin (PR) on wrist function and chronic post-surgical pain (CPSP) following infraclavicular brachial plexus block for surgical repair of distal radius fractures.Methods: Adult patients who underwent ultrasound-guided infraclavicular blockade (IB) plus surgical repair of a distal radius fracture between 2012 and 2017 were evaluated from hospital medical records retrospectively. Two different treatment protocols were used for postoperative analgesia. Group IB received standard analgesia protocol as 15 mg/kg IV paracetamol 4 times a day +/- 2 mg/kg IV tramadol and group PR received oral PR plus the standard protocol. The frequency of Tramadol use during hospital stay (TCHS) was also evaluated. The disability of the arm shoulder and hand (DASH) score and Mayo wrist score (MWS) were used to assess wrist function and a visual analog scale (VAS) was used for subjective pain severity assessment. CPSP and its neuropathic component were evaluated using the douleur neuropathique 4 (DN4) and Self-completed Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) pain scales.Results: A total of 122 patients with a mean age 39.4 +/- 11.5 years were included in the study (group IB, n=62 and group PR, n=60). The TCHS of group PR was significantly lower than group IB (p=0.030). Better VAS, DASH and MWS scores were found in group PR at months 3, 6, and 12 (p=0.002, p=0.007, p=0.02 for VAS; p=0.01, p=0.01, p=0.01 for DASH; p<0.001, p<0.001, p=0.01 for MWS). The ratio of neuropathic pain according to DN4 and S-LANSS scores of group PR was also significantly lower than group IB at 6-and 12-month visits (p=0.21, p=0.023 for DN4; p=0.034, p=0.038 for S-LANSS).Conclusion: The administration of low dose PR for 2 weeks following distal radius fracture surgery is beneficial for wrist function, chronic pain, and opioid consumption.