Pregabalin (Perioperative)

How it works

Pregabalin binds the alpha-2-delta subunit of voltage-gated calcium channels, reducing presynaptic release of excitatory neurotransmitters involved in pain signalling.

Prescribing in practice

• Sedation and respiratory depression are additive with opioids and other CNS depressants in the perioperative period — the combination increases the risk of excessive sedation and breathing problems, so co-prescribe and monitor carefully, especially in the elderly.
• Reduce the dose in renal impairment, as pregabalin is renally cleared and accumulates.
• Pregabalin is a controlled drug with recognised misuse potential; avoid abrupt discontinuation after prolonged use and weigh the limited analgesic benefit against harms.

Monitoring

Monitor sedation, respiratory status and pain scores when combined with opioids, with particular vigilance in older or renally impaired patients.

Counselling the patient

• This medicine may be used to help with pain around surgery and to reduce the need for strong painkillers.
• It can make you drowsy or dizzy, especially with other painkillers.
• Do not stop it suddenly if you have been taking it regularly.

Evidence & guidelines

Evidence for perioperative gabapentinoids shows modest opioid-sparing offset by sedation, and routine use is no longer broadly endorsed.