Comparison of pregabalin with magnesium sulfate in the prevention of remifentanil-induced hyperalgesia in patients undergoing rhinoplasty: A randomized clinical trial.

[OBJECTIVE] Remifentanil is usually used for controlled hypotension during rhinoplasty under general anesthesia (G/A). One of the complications of the remifentanil is postoperative hyperalgesia. In this study, we compare the effectiveness of pregabalin with that of Mg sulfate in postoperative remifentanil-induced hyperalgesia prevention.

[METHODS] In this prospective, randomized, double-blinded placebo-controlled trial, 105 patients who candidates rhinoplasty with G/A were enrolled and randomly allocated into three groups. Patients in group A received 300 mg pregabalin before anesthesia. They received physiologic saline infusion during the perioperative period. Those in group B received placebo capsules before anesthesia and intravenous Mg sulfate 30 mg/kg during the perioperative period. Those in group C received a placebo capsule before anesthesia and normal intravenous saline during the operation. Then, pain severity, sedation score, postoperative nausea and vomiting (PONV) were assessed and compared.

[RESULTS] In the Mg sulfate and placebo group, the mean numerical rating scale in the postoperative period was higher compared to the pregabalin group ( < .001). The mean total amount of morphine requirement, meanwhile the 24 h post-operation, was significantly decreased in the pregabalin group compared to the other groups ( < .001). Participants in the pregabalin group had less PONV compared to those in the pregabalin and placebo groups ( = .015).

[CONCLUSIONS] In patients undergoing G/A with remifentanil for rhinoplasty, preoperative 300 mg pregabalin could effectively prevent not only remifentanil-induced hyperalgesia but also PONV.

[LEVEL OF EVIDENCE] 1b.