Perioperative oral pregabalin or clonidine in patients undergoing lumbar spine posterior fusion: A randomized controlled trial

Background
Multiple techniques and pharmacological efforts have been tried to control intraoperative hemodynamic fluctuations, reduce perioperative blood loss and severe postoperative pain. This study aimed to assess the perioperative effects of oral premedication with pregabalin or clonidine for lumbar spine posterior fusion under general anesthesia (GA). Outcome measures: Perioperative blood loss, hemodynamics, anesthetics consumption, postoperative pain, and side effects
Methods
This is a prospective, triple blinded randomized placebo-controlled trial (RCT). Ninety-six adult ASA I-II patients of either sex undergoing lumbar spine posterior fusion were randomly assigned to obtain a placebo (group E), pregabalin 300 mg (group P), or clonidine 200 μg (group C) orally 90 minutes before induction of GA. Trial registration: with (PACTR201710002416280).
Results
Preemptive oral pregabalin 300 mg and clonidine 200 μg optimized intraoperative hemodynamics, reduced perioperative blood loss than the placebo group (by 22.2% and 30.7%, respectively), reduced postoperative pain scores, and anesthetic and postoperative analgesic consumption. In addition, they prolonged the duration to the first postoperative analgesic request. There was no major complication in any group.
Conclusion
Premedication with pregabalin or clonidine reduced perioperative blood loss and optimized intraoperative and postoperative hemodynamics, with the preference for clonidine over pregabalin as well as both reduced postoperative pain scores, analgesic requirements, PONV, and shivering. Sedative drugs should be used in lower doses to avoid oversedation. Pregabalin-associated dizziness and visual disturbance may necessitate extra precautions and patient education.