The Effect of Pregabalin-Paracetamol on Shoulder Pain in Patients Following Laparoscopic Cholecystectomy: A Randomized Clinical Trial.

Abstract

Background: Shoulder pain is widely recognized as one of the most prevalent complications following cholecystectomy procedures. The management of postoperative shoulder discomfort primarily relies on pharmacological interventions. Pregabalin, a commonly prescribed medication, is valued for its efficacy in modulating neuropathic pain.

Objectives: This study aimed to evaluate the impact of preoperative pregabalin, in combination with paracetamol, on the control of shoulder pain after cholecystectomy.

Methods: This randomized, double-blind clinical trial enrolled 90 patients aged 20 - 60 years, scheduled for cholecystectomy at Imam Ali Hospital in Bojnourd in 2023. Patients were selected by convenience sampling and randomly assigned to one of three groups. The first group received 300 mg of oral pregabalin one hour before surgery, as well as 1 g of intravenous paracetamol 30 minutes before the end of the operation, followed by dosing every 6 hours for 24 hours. The second group received only oral pregabalin as premedication one hour prior to surgery. The third group received standard care (standard multimodal analgesia with diclofenac as needed), without pregabalin or paracetamol. The primary outcome was the severity of shoulder pain during recovery and at 6, 12, 18, and 24 hours postoperatively, measured using the Visual Analog Scale (VAS).

Results: Significant differences were observed in the severity of postoperative shoulder pain among the three groups at all-time intervals (P < 0.05). Inter-group comparisons revealed that the severity of shoulder pain in the first group was significantly lower than in the third group at all-time points (P < 0.05). Additionally, the second group exhibited significantly lower shoulder pain severity compared to the third group at all-time points except at 18 and 24 hours postoperatively (P < 0.05). There was a notable reduction in pain severity over time in the first and second groups (P < 0.001).

Conclusions: According to the study findings, premedication with oral pregabalin and intravenous paracetamol effectively alleviated postoperative shoulder pain across all time intervals without adverse effects. Pregabalin premedication alone also demonstrated analgesic effects, though with a shorter duration compared to the combination regimen.