Preoperative Gabapentinoids Reduce Postoperative Pain in Lumbar Narrow Canal Surgery

Abstract

The success of pre-emption depends on the strategy pertaining to the choice of agent and when and how to use it. This study aimed to evaluate the efficacy of preemptive analgesia regarding postoperative pain management in lumbar spinal stenosis surgery. Postoperative pain arises through multiple physiological and pathological mechanisms, including nociceptive inputs resulting from incision and peripheral and central sensitization via nerve growth factor, cytokines, and \(\alpha\)-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor. On the other hand, surgical insult and nerve damage caused by surgical removal are the basis of postoperative acute pain. Preventive analgesia provided neuroprotection in addition to reducing postoperative pain. The use of an analgesic drug before the onset of a painful stimulus is known as preemptive analgesia. It prevents the formation of altered afferent input processing, which worsens post-operative pain. The use of gabapentinoids (e.g. gabapentin/pregabalin) in acute pain has become more prevalent, particularly in enhanced recovery protocols. Initial studies indicated improved postoperative pain relief and reduced opioid use, but this was traded against an increased risk of sedation. Lumbar spinal stenosis (LSS) relates to the gradual narrowing of the spinal canal which causes discomfort in walking. In conclusion, the preoperative oral administration of gabapentin or pregabalin may reduce postoperative pain, delay the pain medication requirement, and decrease the overall usage of analgesics in patients undergoing lumbar canal stenosis surgery.