Newly Published
Perioperative Medicine  |   October 2018
Cognitive Effects of Perioperative Pregabalin: Secondary Exploratory Analysis of a Randomized Placebo-controlled Study
Author Notes
  • From the Department of Pain Management and Research (H.B.J., A.S.), Department of Anesthesiology, Division of Emergencies and Critical Care (M.M.), Oslo University Hospital, Rikshospitalet, Oslo, Norway; and the Institute of Medicine, Faculty of Medicine (M.M., A.S.) and the Department of Psychology (S.A.), University of Oslo, Oslo, Norway.
  • Submitted for publication January 13, 2018. Accepted for publication September 6, 2018.
    Submitted for publication January 13, 2018. Accepted for publication September 6, 2018.×
  • Correspondence: Address correspondence to Dr. Myhre: Oslo University Hospital, Rikshospitalet, P.O. Box 4950, Nydalen, N-0424 Oslo, Norway. marianne.myhre@medisin.uio.no. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Central and Peripheral Nervous Systems / Pain Medicine / Pharmacology / Opioid
Perioperative Medicine   |   October 2018
Cognitive Effects of Perioperative Pregabalin: Secondary Exploratory Analysis of a Randomized Placebo-controlled Study
Anesthesiology Newly Published on October 17, 2018. doi:10.1097/ALN.0000000000002473
Anesthesiology Newly Published on October 17, 2018. doi:10.1097/ALN.0000000000002473
Abstract

Editor’s Perspective:

What We Already Know about This Topic:

  • Perioperative administration of pregabalin has been associated with decreased postoperative pain and opioid requirements

What This Article Tells Us That Is New:

  • This secondary analysis of data demonstrating that perioperative administration of pregabalin was associated with a reduction in opioid requirements and incisional hyperalgesia suggests that these benefits may be compromised by an increased risk of developing impaired postoperative cognitive performance

Background: Pregabalin has shown opioid sparing and analgesic effects in the early postoperative period; however, perioperative effects on cognition have not been studied. A randomized, parallel group, placebo-controlled investigation in 80 donor nephrectomy patients was previously performed that evaluated the analgesic, opioid-sparing, and antihyperalgesic effects of pregabalin. This article describes a secondary exploratory analysis that tested the hypothesis that pregabalin would impair cognitive function compared to placebo.

Methods: Eighty patients scheduled for donor nephrectomy participated in this randomized, placebo-controlled study. Pregabalin (150 mg twice daily, n = 40) or placebo (n = 40) was administered on the day of surgery and the first postoperative day, in addition to a pain regimen consisting of opioids, steroids, local anesthetics, and acetaminophen. Specific cognitive tests measuring inhibition, sustained attention, psychomotor speed, visual memory, and strategy were performed at baseline, 24 h, and 3 to 5 days after surgery, using tests from the Cambridge Neuropsychological Test Automated Battery.

Results: In the spatial working memory within errors test, the number of errors increased with pregabalin compared to placebo 24 h after surgery; median (25th, 75th percentile) values were 1 (0, 6) versus 0 (0, 1; rate ratio [95% CI], 3.20 [1.55 to 6.62]; P = 0.002). Furthermore, pregabalin significantly increased the number of errors in the stop-signal task stop-go test compared with placebo; median (25th, 75th percentile) values were 3 (1, 6) versus 1 (0, 2; rate ratio, 2.14 [1.13 to 4.07]; P = 0.020). There were no significant differences between groups in the paired associated learning, reaction time, rapid visual processing, or spatial working memory strategy tests.

Conclusions: Perioperative pregabalin significantly negatively affected subdomains of executive functioning, including inhibition, and working memory compared to placebo, whereas psychomotor speed was not changed.