Impact of Pre-Emptive Analgesia and Opioid use on Postoperative Pain in Patients undergoing Major Orthopaedic Surgeries

Abstract

Background: Postoperative pain is a common and serious issue affecting patient recovery. Pre-emptive analgesia, which blocks pain signals before surgery, can significantly reduce postoperative pain.
Objective: This study evaluated pre-emptive analgesia using oral pregabalin (150mg) and intravenous paracetamol (1gm) in reducing postoperative pain intensity using the Visual Analogue Scale. It compared pain scores at various time points between both the groups, total opioid consumption and its related side effects post-operatively and the time for first rescue analgesic.
Methods: This Prospective Cohort Study was performed on 82 patients undergoing major orthopaedic surgeries. Patients were randomly allocated to Group A receiving pre-emptive analgesia, while group B received only standard post-operative treatment, in both the groups pain intensity at 1,6,8,12,24 and 48 hours postoperatively,cumulative amount of opioid consumption,time for first rescue analgesia, PONV and sedation were compared.
Results: Group A had significantly lower pain scores at 6 (p < 0.001), 8 (p = 0.008), and 12 hours(p = 0.012). Time to first rescue analgesia was longer in Group A (p < 0.001). Opioid use was reduced by 69%, with fentanyl required only in Group B (p < 0.001). Sedation scores at 2 and 6 hours, and PONV at 12 hours, were also significantly lower in Group A (p < 0.05).
Conclusion: Pre-emptive oral pregabalin and intravenous paracetamol significantly improved postoperative analgesia and reduced opioid consumption post-operatively in major orthopaedic surgeries. Pain scores were consistently lower, with delayed rescue analgesia and fewer opioid-related side effects.