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Purpose <p>Multimodal analgesia is standard for post-laminectomy pain. This study evaluated two intravenous dexamethasone doses, with or without oral pregabalin, within this framework.</p> Methods <p>In this randomized, double-blind, placebo-controlled trial, 800 adult patients undergoing elective 2–3 level lumbar laminectomy were allocated to: Group A (8&#xa0;mg IV dexamethasone + 150&#xa0;mg oral pregabalin), Group B (8&#xa0;mg IV dexamethasone + oral placebo), Group C (4&#xa0;mg IV dexamethasone + 150&#xa0;mg oral pregabalin), or Group D (4&#xa0;mg IV dexamethasone + oral placebo). Drugs were given preemptively. Primary outcome was pain scores (Visual Analogue Scale, VAS) over 24&#xa0;h. Secondary outcomes included 24-hour opioid consumption (calculated as total morphine equivalents), time to first rescue analgesia, hemodynamics, adverse events (assessed using standardized scales including Ramsay Sedation Scale for sedation), and surgical site infection within 30 days.</p> Results <p>All patients completed the protocol. Statistically significant differences in VAS scores were observed among groups at all time points (<i>p</i> &lt; 0.001), with Group A reporting the lowest scores. Twenty-four-hour opioid consumption was also significantly different (<i>p</i> &lt; 0.001), being lowest in Group A. A formal factorial analysis indicated a statistically significant interaction effect (<i>p</i> = 0.012) between the higher dexamethasone dose and pregabalin. Sedation/dizziness was more frequent in pregabalin groups (A: 22.5%; C: 20.0%) versus placebo groups (B &amp; D: 5.0% each; <i>p</i> &lt; 0.001). No significant differences in surgical site infections or hyperglycemia were noted.</p> Conclusion <p>this selected cohort, preemptive administration of 8&#xa0;mg IV dexamethasone combined with 150&#xa0;mg oral pregabalin significantly reduced pain scores and opioid requirements over 24&#xa0;h compared with lower doses or monotherapy. The combination also provided better hemodynamic stability but increased neurosedative effects. This regimen may be a potential option for multimodal analgesia in spinal surgery, but further studies are needed to confirm generalizability.</p> Level of evidence: <p>1.</p>

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Combination of dexamethasone and pregabalin for postoperative pain after laminectomy: a randomized controlled trial

  • 期刊论文

  • 发表日期：

    2026年4月20日

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  • Asghar Elmi,
  • Aran Nikpay,
  • Ali Sadighi,
  • Misagh Osquee Asanjani,
  • Sajjad Valizadeh,
  • Amanj Nabavi,
  • Mehrdad Zamani

摘要

Purpose

Multimodal analgesia is standard for post-laminectomy pain. This study evaluated two intravenous dexamethasone doses, with or without oral pregabalin, within this framework.

Methods

In this randomized, double-blind, placebo-controlled trial, 800 adult patients undergoing elective 2–3 level lumbar laminectomy were allocated to: Group A (8 mg IV dexamethasone + 150 mg oral pregabalin), Group B (8 mg IV dexamethasone + oral placebo), Group C (4 mg IV dexamethasone + 150 mg oral pregabalin), or Group D (4 mg IV dexamethasone + oral placebo). Drugs were given preemptively. Primary outcome was pain scores (Visual Analogue Scale, VAS) over 24 h. Secondary outcomes included 24-hour opioid consumption (calculated as total morphine equivalents), time to first rescue analgesia, hemodynamics, adverse events (assessed using standardized scales including Ramsay Sedation Scale for sedation), and surgical site infection within 30 days.

Results

All patients completed the protocol. Statistically significant differences in VAS scores were observed among groups at all time points (p < 0.001), with Group A reporting the lowest scores. Twenty-four-hour opioid consumption was also significantly different (p < 0.001), being lowest in Group A. A formal factorial analysis indicated a statistically significant interaction effect (p = 0.012) between the higher dexamethasone dose and pregabalin. Sedation/dizziness was more frequent in pregabalin groups (A: 22.5%; C: 20.0%) versus placebo groups (B & D: 5.0% each; p < 0.001). No significant differences in surgical site infections or hyperglycemia were noted.

Conclusion

this selected cohort, preemptive administration of 8 mg IV dexamethasone combined with 150 mg oral pregabalin significantly reduced pain scores and opioid requirements over 24 h compared with lower doses or monotherapy. The combination also provided better hemodynamic stability but increased neurosedative effects. This regimen may be a potential option for multimodal analgesia in spinal surgery, but further studies are needed to confirm generalizability.

Level of evidence:

1.