CORRESPONDENCE Brian F. S. Allen , M.D. , Matthew D. McEvoy , M.D. Vanderbilt Cognitive Effects of University Medical Center, Nashville, Tennessee (B.F.S.A.). email@example.com Perioperative Pregabalin: DOI: 10.1097/ALN.0000000000002871 Comment References 1. Myhre M , Jacobsen HB , Andersson S , Stubhaug A : Cognitive e ects of perioperative pregabalin: To the Editor: Secondary exploratory analysis of a randomized place- bo-controlled study. A 2019 ; 130 : 63 – 71 e read with interest the recent article by Myhre e t Wal . concerning the e ects of pregabalin on cog- (Accepted for publication June 3, 2019.) nitive function in the perioperative period. The authors note that there were signi cant changes in several compo- nents of the battery of tests, thus leaving the reader with the conclusion that pregabalin may cause signi cant det- Cognitive Effects of riment and demonstrably raise the risk of harm, including an increased risk of fall or behavior that would increase Perioperative Pregabalin: “ risk of re-injury ” (presumably wound dehiscence or other injury). Reply As we routinely use nonopioid multimodal analge- sia in our practice of perioperative pain management, we have several questions about this article and the data presented. First, was any reduction in dosage considered if the patient experienced side e ects of the pregaba- lin? This is important as the patients were likely na ï ve In Reply: to gabapentinoids and the dose utilized is the maximum rs. Allen and McEvoy have some very important com- dose that has been studied perioperatively (300 mg/day). Dments and questions about our article that we are Second, it would be helpful for the authors to note the happy to answer. We nd that their input is valuable and test-retest reliability of this battery of tests and the cor- relevant, and we thank them for their e ort. relation between them. The authors ’ conclusions sug- In their letter, they note that they routinely use nonopi- gested a signi cant risk, yet only two of the ve tests oid multimodal analgesia in their practice of perioperative showed any change from baseline and all of the tests were pain management. We understand this, as pregabalin is part only administered once at each time point. Additionally, of that routine. One of our key messages is that pregabalin with approximately 20% of the patients in the control many places is used routinely perioperatively even if this group not participating at 24 h due to pain or postoper- is o -label use without proper documentation of e cacy ative nausea and vomiting, could the authors comment and safety. A quite recent editorial in A dis- on how stable their results would be if they assumed that cussed this topic related to pregabalin in particular. these patients displayed poor function due to increased Drs. Allen and McEvoy ask if any reduction in dosage of pain or an opioid e ect? Third, it is unclear to the reader pregabalin was considered if the patient experienced side that a fraction of an error in two of the tests is a mean- e ects of pregabalin. They also comment that they believe ingful clinical di erence at 3 to 5 days. What is the signif- the dose was high (300 mg/day). icance of 0.28 or 0.43 errors in actual practice? Finally, The dose used is the recommended dose in several as the authors associate the change in executive function 4 , 5 publications. Our study di ers from clinical practice, as with an increased risk of fall in both the introduction it was a randomized and double-blinded trial, and indi- and the discussion sections, it would be helpful for the vidual titration of dose was not feasible. Of course, we reader to know whether this is speculative or if this event had “ stop rules, ” and possibility for unblinding in case actually occurred in any patient. of emergencies, but this was not needed except for one patient described in the ow chart who received only Competing Interests 450/600 mg pregabalin due to diplopia. Besides, we think The authors declare no competing interests. that dose reduction due to side e ects is quite di cult Copyright © 2019, the American Society of Anesthesiologists, Inc. All Rights Reserved. Anesthesiology 2019; 131:753–6 ANESTHESIOLOGY, V 131 • NO 3 SEPTEMBER 2019 753 ALNV131N03_Text.indb 753 01-Aug-19 6:23:47 AM
Anesthesiology – Wolters Kluwer Health
Published: Sep 1, 2019
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