Preoperative Pregabalin and the Cp50 for Skin Incision During Target-Controlled Propofol Infusion: A Randomized, Placebo-Controlled, Double-Blind Clinical Trial
Year: 2025
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: BACKGROUND: The potency of propofol is measured by its Cp50 value, which is the plasma concentration required to suppress a motor response in 50% of patients during surgical incisions. This Cp50 value can be affected by the concurrent use of other drugs, including opioids, benzodiazepines, or lidocaine. Pregabalin, a medication commonly administered as preoperative premedication, provides mild sedative and anxiolytic effects. Although pregabalin has the potential to reduce the minimum alveolar concentration (MAC) of sevoflurane, its effects on propofol-based anesthesia have not been conclusively studied. Thus, we designed a placebo-controlled, double-blind clinical trial to evaluate the impact of pregabalin on the Cp50 of propofol. METHODS: Eighty female patients who underwent breast surgery participated in this study. They received either a placebo or 300 mg of pregabalin 2 hours before anesthesia induction. Propofol was administered as the sole anesthetic agent, delivered continuously via a target-controlled infusion (TCI) pump using the Schnider model, without the addition of opioids or other analgesics. Patients in both groups were administered different target effect-site propofol concentrations, and their motor responses to standardized skin incisions were determined. The Cp50 value of propofol was estimated using a logistic regression model, and the results were re-evaluated using bootstrap methods. RESULTS: A significant difference in propofol Cp50 values was found between the placebo and pregabalin groups. Using the delta method, the Cp50 value of propofol was estimated to be 16.9 μg/mL (95% confidence interval [CI], 15.1-18.8) in the placebo group and 9.4 μg/mL (95% CI, 4.46-14.3) in the pregabalin group. Secondary outcome measures revealed significantly decreased opioid consumption and pain levels in the recovery area in the pregabalin group compared to the placebo group. CONCLUSIONS: This study demonstrated that pretreatment with 300 mg pregabalin significantly reduced the Cp50 value of propofol by 44%, as calculated using the delta method. When 300 mg of pregabalin is administered before anesthesia and propofol is used for maintenance via TCI, a lower target effect-site concentration might be sufficient. Additionally, pregabalin premedication has the potential to decrease postoperative pain and opioid consumption.
Source: Anesthesia & Analgesia
Authors: Johannes Müller, Roxana Polojintef-Corbu, Stefan Ulbing, Alexandra Graf, Birgit Reiter, Thomas Stimpfl, Walter Plöchl
Institution: Medical University of Vienna
Language: English
Subfield: Anesthesiology and Pain Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4415700103