E-ISSN: 1019-5157
ISSN: 2651-5024
Research
Dose- and Duration-Dependent Effects of Preoperative Gabapentin and Pregabalin on Acute Postoperative Pain After Lumbar Microdiscectomy: A Prospective Randomized Double-Blind Trial
Sevki Gok✉ ,
Recep Basaran
Neurosurgery, Uskudar University Faculty of Medicine; Neurosurgery, University of Health Sciences Sancaktepe Training and Research Hospital
DOI: 10.5137/1019-5149.JTN.52050-26.3
Accepted: 18/09/2026
Article in Press
Corresponding Author:
Sevki Gok (drsevkigk@hotmail.com)
Abstract
Aim
Gabapentinoids are frequently used as part of multimodal analgesia strategies in spinal surgery. However, the optimal molecule, dose, and duration of preoperative administration remain unclear.
Material and Methods
In this prospective randomized double-blind clinical trial, 198 patients undergoing elective lumbar microdiscectomy were allocated into nine groups receiving pregabalin (75–150 mg) or gabapentin (300–600 mg) for either 1 day or 3 days preoperatively, or placebo. Postoperative pain intensity was assessed using the Visual Analog Scale (VAS) at 1, 6, 12, and 24 hours. The primary outcome was VAS score at 24 hours. Secondary outcomes included earlier VAS measurements and adverse events.
Results
Gabapentin demonstrated significant dose- and duration-dependent reductions in postoperative pain scores compared with placebo. Short-term high-dose gabapentin (600 mg) provided the most favorable balance between analgesic efficacy and safety. Prolonged high-dose administration was associated with increased adverse events. Pregabalin did not demonstrate consistent clinically meaningful reductions in postoperative pain across different doses and durations.
Conclusion
Preoperative gabapentin appears to provide effective acute postoperative analgesia following lumbar microdiscectomy, particularly when administered as a short-term high-dose regimen. Optimization of dose and duration may improve perioperative pain control while minimizing adverse effects. Further multicenter studies are warranted to confirm these findings.
Gabapentinoids are frequently used as part of multimodal analgesia strategies in spinal surgery. However, the optimal molecule, dose, and duration of preoperative administration remain unclear.
Material and Methods
In this prospective randomized double-blind clinical trial, 198 patients undergoing elective lumbar microdiscectomy were allocated into nine groups receiving pregabalin (75–150 mg) or gabapentin (300–600 mg) for either 1 day or 3 days preoperatively, or placebo. Postoperative pain intensity was assessed using the Visual Analog Scale (VAS) at 1, 6, 12, and 24 hours. The primary outcome was VAS score at 24 hours. Secondary outcomes included earlier VAS measurements and adverse events.
Results
Gabapentin demonstrated significant dose- and duration-dependent reductions in postoperative pain scores compared with placebo. Short-term high-dose gabapentin (600 mg) provided the most favorable balance between analgesic efficacy and safety. Prolonged high-dose administration was associated with increased adverse events. Pregabalin did not demonstrate consistent clinically meaningful reductions in postoperative pain across different doses and durations.
Conclusion
Preoperative gabapentin appears to provide effective acute postoperative analgesia following lumbar microdiscectomy, particularly when administered as a short-term high-dose regimen. Optimization of dose and duration may improve perioperative pain control while minimizing adverse effects. Further multicenter studies are warranted to confirm these findings.
Keywords
Lumbar Microdiscectomy
Postoperative Pain
Gabapentin
Pregabalin
Randomized Controlled Trial
Multimodal Analgesia