PREGABALIN SINGLE DOSE IN FUNCTIONAL ENDOSCOPIC SINUS SURGERY ANALGESIC AND ANTIPLATLET EFFECT

To evaluate the impact of preoperative oral pregabalin on platelet function and extent of blood loss during functional endoscopic sinus surgery (FESS) in patients with chronic rhinosinusitis as judged by intraoperative field visibility as well as postoperative analgesia. Patients Methods: The study included 30 patients; 19 males and 11 females, with mean age of 26.3±2.6 years divided randomly into two equal groups: Group I and Group II received oral pregabalin 300 mg or placebo one-hour preoperatively. All patients underwent complete otorhinolaryngological examination and endoscopic evaluation of the extent of the disease according to the endoscopic staging proposed by Lund Kennedy and CT scan of paranasal sinuses were assessed according to Lund-Mackay scale. Operative field bleeding and subsequently its visibility was graded using 6-point scale, total amount of bleeding as judged by the amount evacuated and operative times were recorded. Post-operative pain was assessed using 10-points visual analogue scale (VAS) hourly for 6- hours and rescue analgesia in the form of intramuscular nulbufen was administered at VAS≥4. Platelet aggregation was determined preoperatively and 6 hours after surgery (6-hr PO). Results: Mean amount of blood loss was significantly higher and mean total field visibility score was significantly lower with pregabalin compared to group despite the non-significantly higher frequency of high bleeding scores in pregabalin compared to placebo group. Mean duration of postoperative analgesia was significantly longer with pregabalin compared to placebo. Four patients in placebo group required rescue analgesia trice in the form of nulbufen 10mg, 6 patients required it twice and 20 patients required it once with significant difference in favor of pregabalin priming. Moreover, patients primed by pregabalin requested rescue analgesia more lately compared to those received placebo. Both VAS score determined at 1st hour postoperatively and the total cumulative VAS scores were significantly lower with pregabalin compared to placebo in favor of pregabalin. Patients received pregabalin showed significantly lower platelet aggregation at 6-hr PO compared to placebo. Conclusion: Despite the beneficial effects of preemptive pregabalin as analgesic for intra and postoperative pain with reduction of rescue analgesia consumption, it affects platelet aggregation which increases intraoperative blood loss and can affect field visibility so is not the appropriate drug for such type of surgical procedures.