Chronic Postoperative Pain, Headache
Conditions
Keywords
post-craniotomy pain, pregabalin, chronic post-craniotomy headache, Craniotomy
Brief summary
Objective: To compare the incidence of chronic pain at 3 months among adults undergoing craniotomy between those received two different doses of pregabalin and those receiving placebo.
Detailed description
Hypothesis: Perioperative pregabalin will reduce the incidence of chronic post-operative pain, and will reduce the opioid consumption, opioid-related side effects, and hospital length of stay compared with placebo in patients undergoing elective craniotomy. Methods: 316 adults (18-65y), ASA I-III, undergoing elective craniotomy will be randomized to receive: 100mg or 150mg pregabalin or placebo once pre-operatively and 50mg or 75mg or placebo twice daily for 14 post-operative days. NRS pain scores, opioid consumption and side effects will be assessed up to 48h, and long-term pain at days 7, 14, 30, and 90. The primary analysis will involve the comparison between the 2 treatment groups together vs. placebo. A stepwise method will be used to evaluate the pairwise comparisons. Outcomes: The primary outcome will be the incidence of chronic post-craniotomy pain at 3 mos. Important secondary outcomes are: neuropathic component of pain at 3 mos., total opioid consumption in the first 24h, and incidence and severity of opioid-related side effects at days 1, 2 and 7.
Interventions
DRUGPregabalin
Pre-operatively, one of the 2 doses of pregabalin (100 or 150 mg) or placebo will be given to patients 1 hour before the surgery. Post-operatively, patients will receive daily (split in 2 equal doses) pregabalin 100 mg, pregabalin 150 mg, or placebo for the first 14 post-operative days.
DRUGpregabalin
Pre-operatively, one of the 2 doses of pregabalin (100 or 150 mg) or placebo will be given to patients 1 hour before the surgery. Post-operatively, patients will receive daily (split in 2 equal doses) pregabalin 100 mg, pregabalin 150 mg, or placebo for the first 14 post-operative days.
DRUGplacebo
Identical placebo capsules will be administered in the same way.
Sponsors
Unity Health Toronto
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Adults, 18 to 65 years (limited to 65 years to lower the risk of over-sedation for elderly patients) * Undergoing elective craniotomy (supratentorial or infratentorial) under general anaesthesia for: biopsy or resection of a tumour, clipping of an unruptured aneurysm, or excision of an arteriovenous malformation * ASA physical status I-III
Exclusion criteria
* predicted need for prolonged post-operative ventilation (\> 12 hours) * chronic pain secondary to previous craniotomy * known adverse reaction to drugs used (gabapentin, pregabalin, hydromorphone, and/or acetaminophen) * prior use of pregabalin or gabapentin (within 2 weeks before surgery) * current history of moderate to severe headaches (NRS ≥ 4) related to intracranial pathology (tumour pain) since it may be difficult to discriminate between ongoing tumour pain and surgery-related post-operative pain * current history of migraines * pre-existing chronic pain requiring chronic opioid use (30mg morphine equivalent within 4 weeks of surgery) * currently taking any drug that could interact with pregabalin * current history of alcohol or recreational drug abuse * known or suspected addiction to narcotic substances or chronic narcotic use in the last 2 weeks * history of malignant hyperthermia (contraindicates the anaesthesia protocol of this study) * history of angioedema * Body Mass Index ≤ 18.4 or ≥ 35 * history of untreated obstructive sleep apnea * any condition that would contraindicate the use of patient-controlled analgesia (PCA) * lacks fluency in English * pre-existing renal impairment (for pregabalin elimination) * pregnancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Chronic post-craniotomy pain | 3 months | The primary outcome of this study will be the incidence of chronic post-craniotomy pain at 3 months |
Secondary
| Measure | Time frame |
|---|---|
| incidence of long-term pain at days 7 | Day 7 |
| incidence of long-term pain at day 14 | Day 14 |
| incidence of long-term pain at day 30 | Day 30 |
| total opioid consumption in the first 24h | 24 hours |
| total patient-controlled analgesia (PCA)demands and delivered doses in 24h | 24 hours |
| post-operative pain scores at 24h | 24 hours |
| neuropathic component of the pain at 3 months | 3 months |
| incidence and severity of opioid-related side effects at day 2 | Day 2 |
| incidence and severity of opioid-related side effects at Day 7 | Day 7 |
| consumption of antiemetics in the first 24h | 24 hours |
| tracheal extubation time | within 24 hours |
| length of hospital stay | 30 days |
| post-operative pain scores at 48h | 48 hours |
Countries
Canada
Outcome results
None listed