Analgesic Efficacy of Administering Celecoxib, Pregabalin, or the Combination for Spinal Fusion Surgery Scott S. Reuben, MD, Asokumar Buvanendran, MD, Jeff S. Kroin, PhD, Karthik Raghunathan, MD, MPH Department of Anesthesiology, Baystate Medical Center, Springfield, MA ~ The Western Campus of Tufts University School of Medicine Department of Anesthesiology, Rush University Medical Center, Chicago, IL BACKGROUND MATERIALS AND METHODS
• A multimodal analgesic approach is currently Following hospital IRB approval, 80 patients scheduled to undergo
• There were no differences in demographics, surgical
recommended for the management of acute pain (1). elective decompressive lumbar laminectomy with posterior spinal fusion
duration, or number of spinal levels fused.
• Recent evidence suggests that alpha-2-delta subunit were randomized to receive oral medications:
• The pregabalin/celecoxib group consumed the least
calcium channel ligands (gabapentin and pregabalin), 1) placebo 1 h before and 12 h after surgery
amount of patient-controlled morphine (Figure 1). may provide effective post-surgical analgesia (2). 2) celecoxib 400 mg 1 h before and celecoxib 200 mg 12 h after surgery
• Celecoxib alone or pregabalin alone also reduced
• Further, these drugs can interact synergistically pregabalin 150 mg 1 h before and 12 h after surgery
opioid use compared to placebo, but not as much as
with NSAIDs to produce antihyperalgesia (3). 4) pregabalin/celecoxib combination of 150 mg/400 mg 1 h before and 150
• The combination of gabapentin and rofecoxib, a mg/200 mg 12 h after surgery.
• The pregabalin/celecoxib combination was the most
COX-2 NSAID, was shown to be superior to either Morphine consumption with patient-controlled anesthesia (PCA), and
effective treatment for reducing pain both at rest and
single agent for postoperative pain (4). pain scores (0-10 verbal rating scale) at rest and with movement, were
with movement over the 24-h postoperative time period.
• Celecoxib (5) and gabapentin (6) have demonstrated evaluated for 24 h after the patient arrived in the post-anesthesia care
• Hemodynamics and respiratory rate did not differ
analgesic efficacy following spinal fusion surgery. unit (PACU). Sedation scores, heart rate, oxygen saturation, mean blood pressure,
• Fewer patients experienced nausea or excessive
respiratory rate, and opioid-related side-effects were also recorded.
sedation in the pregabalin/celecoxib group compared to
Morphine consumption, pain, heart rate, mean arterial blood pressure, and respiratory rate were compared among the 4 groups over the postoperative time points with repeated measures linear fixed model. CONCLUSIONS PURPOSE AND HYPOTHESIS
• This study revealed that the perioperative
Figure 1. PCA Morphine Use over 24 h
administration of the combination of celecoxib and
• Although structurally similar to gabapentin,
pregabalin resulted in improved analgesia, with less
pregabalin has demonstrated greater analgesic
opioid consumption and fewer side effects, compared to
efficacy in rodent models of neuropathic pain (7), and
either analgesic agent alone following spinal fusion
exhibits linear pharmacokinetics across its therapeutic dose range with low inter-subject variability (8). BIBLIOGRAPHY
•The goal of this study was to assess the combination of celecoxib and pregabalin for pain following spinal fusion surgery.
Acta Anaesthesiol Scand 2004;48:1130-6.
J Bone Joint Surg Am 2005;87(3):536-42.
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