JU INSIGHT Randomized Controlled Trial of Single-dose Perioperative Pregabalin in Ureteroscopy
By: Geoffrey H. Rosen, MD, University of Missouri, Columbia; Paige A. Hargis, MD, University of Colorado, Denver; Alp Kahveci, MD, School of Medicine, University of Missouri, Columbia; Connor Lough, MD, Loyola University, Chicago, Illinois; Andrew Moss, MD, University of Alabama, Birmingham; Mojgan Golzy, PhD, University of Missouri, Columbia; Katie Murray, DO, NYU-Langone Health, New York, New York | Posted on: 19 Sep 2023
Rosen GH, Hargis PA, Kahveci A, et al. Randomized controlled trial of single-dose perioperative pregabalin in ureteroscopy. J Urol. 2023;210(3):517-528.
Study Need and Importance
Ureteroscopy is among the most commonly performed procedures in urology. Postprocedural pain is frequently difficult to control. Many different strategies have been tried, with varying success. In other arenas, single-dose perioperative pregabalin has been a useful adjunct in preventing/controlling postprocedural pain. We evaluated whether this was helpful in ureteroscopy.
What We Found
We enrolled 118 patients with normal renal function and no regular use of opioids or pregabalin undergoing ureteroscopy for any reason. In a 1:1 ratio, we randomized patients to receive a single dose of 300 mg pregabalin or identical placebo 1 hour before ureteroscopy. We measured pain after the procedure on a 0-10 scale. We also evaluated any cognitive issues. Postprocedural pain was higher in the group that received pregabalin (placebo median [IQR]: 2.0 [0.6,4.2], pregabalin: 3.7 [1.5,6.3], mean difference [95% CI] 1.4 [0.5-2.4]; P = .004; see Figure). The group that received pregabalin was younger on average than the placebo group (a factor known to impact postureteroscopy pain). Controlling for age and preoperative pain, ANCOVA demonstrated statistically significantly higher pain among those who received pregabalin (adjusted P = .02). There was no difference in our proxy measure of cognition between the groups.
This was a single-center pragmatic study, which may limit applicability at other facilities using specific anesthetic regimens. The groups were unbalanced in terms of age, which we attempted to correct for using ANCOVA. Nonetheless, this analysis is unable to control for all variables (measured and unmeasured) fully. Therefore, we believe the best interpretation of our results is that there was no improvement in pain attributable to perioperative pregabalin.
Interpretation for Patient Care
In this trial evaluating the efficacy of single-dose perioperative pregabalin in ureteroscopy, pregabalin did not decrease postoperative pain when compared to placebo. Urologists should not routinely use this adjunctive medication in ureteroscopy, as it is unlikely to provide benefit.