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Single Dose Preoperative Pregabalin Reduces Opioid Consumption In Cleft Orthognathic Surgery
Abdullah M. Said, BA, Austin Y. Ha, MD, Ema Zubovic, MD, Gary B. Skolnick, BS, Sybill D. Naidoo, PhD, Jacob AuBuchon, MD, Kamlesh B. Patel, MD
Washington University, St. Louis, MO, USA.

Purpose: Non-opioid analgesia has become ever more important in the wake of the opioid epidemic. Several studies have demonstrated the efficacy of preoperative pregabalin in decreasing opioid use in adults undergoing orthognathic surgery. We hypothesized that a single dose of preoperative pregabalin would have similar efficacy in reducing opioid consumption in patients undergoing cleft orthognathic surgery.
Methods: This study was a single-institution, retrospective cohort study of consecutive patients with diagnosis of cleft lip and palate who underwent LeFort I midface advancement between June 2012 and July 2019. In June 2016, we implemented administration of a single dose of preoperative pregabalin to all patients undergoing cleft orthognathic surgery; prior to this, patients did not receive preoperative pregabalin. Thus, the control group in this study consists of patients who had surgery prior to June 2016 and the exposure group consists of those who had surgery afterwards. Patients without complete anesthesia or postoperative records or who had concomitant procedures were excluded. The primary outcome variable was total perioperative opioid consumption in morphine milligram equivalents (MME). Secondary outcome variables included patient reported pain scores at 2, 6, 12, 18, and 24 hours post-operatively and length of stay. Baseline and surgery-related variables were also collected. The Mann-Whitney U test, the Student’s t-test, the Fisher’s exact test, and repeated-measures analysis of variance were used appropriately for data analysis.
Results: A total of twenty-four patients, with 12 patients in each group, met the inclusion criteria. The exposure group had significantly lower total perioperative opioid consumption compared to the control group (median 26.0 MME, interquartile range [10.8-83.4] vs. 67.4 MME, [45.5-117.8], Mann-Whitney U = 44, p = 0.039) (Figure 1). For the exposure group, median pain scores at 2, 6, 12, 18, and 24 hours were: 5.0 [2.5-6.5], 1.0 [0.0-2.0], 4.0 [0.0-8.3], 4.5 [2.5-5.0], and 2.0 [1.0-3.5]. The median pain scores of the control group at the same intervals were: 2.0 [1.0-6.0], 5.0 [5.0-6.0], 3.0 [0.0-5.0], 3.0 [1.0-5.0], and 1.0 [0.0-2.3]. These differences were not statistically significant. Both groups spent a median of 1.0 [1.0-1.75] days in the hospital. There were no statistically significant differences between the two groups with respect to baseline and surgery-related variables (Table 1).
Conclusions: In this retrospective cohort study of patients undergoing cleft orthognathic surgery, a single dose of preoperative pregabalin led to a significant reduction in total perioperative opioid consumption without compromising pain control or increasing length of stay.

Table 1. Baseline and Surgery-related Variables
Pregabalin (n = 12)Control (n = 12)
Age (years, median [IQR])18.5 [16.8-18.9]17.8 [15.9-18.3]
Male Sex (n (%))8 (66.7%)6 (50.0%)
Weight
(kg, median [IQR])
59.4 [49.9 - 82.7]65.6 [61.9 – 82.2]
Cleft type (n (%))
Incomplete00
Complete8 (66.7%)8 (66.7%)
Bilateral2 (16.7%)4 (33.3%)
Lesser Form00
Other2 (16.7%)0
Syndromic (n (%))1 (8.3%)0
EBL (mL, median [IQR])225 [113-537]425 [300-700]
Anesthesia Time (minutes, mean ± standard deviation)287.5 ± 28.38268.50 ± 18.89


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