Ami Shah, BCCCP, PharmD, RPh
Critical Care Pharmacy Specialist, Cardiothoracic ICU
n/a
New York, NY
Disclosure information not submitted.
Alopi Patel, MD
Assistant Professor
Mount Sinai Morningside Medical Center, United States
Disclosure information not submitted.
Himani Bhatt, DO, MPA
Associate Professor
Mount Sinai Morningside Medical Center, United States
Disclosure information not submitted.
Anthony Apigo, MD
Anesthesia Resident, Post Grad Year 4
Mount Sinai Morningside Medical Center, United States
Disclosure information not submitted.
Kristy Huang, PharmD
Pharmacist
Mount Sinai Morningside Medical Center, United States
Disclosure information not submitted.
Seana Friedman, DNP, RN
Director of Patient Care Services of Mount Sinai Heart at Morningside
Mount Sinai Morningside Medical Center, United States
Disclosure information not submitted.
Mekeleya Yimen, MD
Assistant Professor
Mount Sinai Morningside Medical Center, United States
Disclosure information not submitted.
John Puskas, MD
Chairman, Cardiovascular Surgery
Mount Sinai Morningside Medical Center, United States
Disclosure information not submitted.
Title: Perioperative Pregabalin Implementation in an Enhanced Recovery After Cardiac Surgery Protocol
Introduction: While traditionally used for the management of chronic neuropathic pain, gabapentinoids have also been utilized off-label for management of acute postoperative pain. Despite extensive studies on the use of postoperative gabapentinoids in a variety of surgical populations, there is inconsistent evidence regarding the efficacy of gabapentinoids in cardiac surgery patients. The objective of this study is to assess the impact of a low dose perioperative pregabalin regimen within an Enhanced Recovery After Cardiac Surgery protocol on perioperative opioid consumption in off-pump cardiac surgery patients.
Methods: All patients greater than 18 years of age admitted to a single tertiary care center for OPCAB procedures were included. Patients were excluded if they had an on-pump CABG, robotic CABG, non-sternotomy cardiac procedures, history of pregabalin use prior to surgery, pregabalin hypersensitivity, or baseline altered mental status. This cohort study compared a retrospective control group (receiving usual perioperative analgesia with no standard pregabalin protocol in place) versus a standardized pregabalin regimen group (x1 pregabalin 75 mg preoperatively, followed by 75 mg twice a day for 48 hours postoperatively in addition to usual care). The primary outcome of postoperative opioid consumption was measured in morphine milligram equivalents (MME) and was determined based on opioid consumption at the end of each postoperative day in the ICU.
Results: A total of 63 patients met inclusion criteria in the control group, compared to 24 patients in the prospective study group. The use of pregabalin demonstrated a significant reduction of opioid consumption on postoperative day 0 following off-pump CABG by 30.6% with median requirement of 318 [233, 397] compared to 458 [375,526] MME in the control group (p< 0.001). In addition, the pregabalin group required less cumulative opioid usage in the ICU compared to the control group (median 76.8 vs. 86.0 MME, p=0.652). No significant differences in adverse effects were noted.
Conclusion: The standardization of perioperative pregabalin significantly reduced opioid utilization by 30.6% on postoperative day zero. The results of this study validate pregabalin’s benefit in reducing opioid consumption as suggested in previous literature on cardiac surgery patients.