Comparison of pregabalin versus gabapentin as pre emptive analgesic in patients undergoing orthopedic surgeries under spinal anesthesia
Abstract
Objective: To compare pregabalin versus gabapentin as pre-emptive analgesic in patients undergoing orthopedic surgeries under spinal anesthesia.
Methodology: This randomized controlled trial was conducted at the Anesthesia Department, Bahawal Victoria Hospital, Bahawalpur, Pakistan, from July 2025 to December 2025. A total of 142 patients (71 per group), aged 20-60 years, ASA I to II, undergoing lower limb orthopedic surgery under spinal anesthesia were randomly allocated to receive gabapentin 300 mg, or pregabalin 150 mg orally 1-hour before spinal anesthesia. Pain was assessed using VAS at predefined intervals, and tramadol was given for VAS >3. Data were analyzed in SPSS v26 using appropriate parametric or non-parametric tests, taking p<0.05 as significant.
Results: In a total of 142 patients, 84 (59.2%) were male and 58 (40.8%) were female. The median age was 42.0 years (IQR 35.5 to 50.0), and above-knee procedures were performed in 84 (59.2%) patients. The baseline VAS was 2.10 ± 0.95. The median duration of surgery was 80.6 minutes (IQR 65.5 to 100.9). Mean duration of postoperative analgesia was longer with pregabalin than gabapentin, 2.84 ± 0.39 hours versus 2.26 ± 0.32 hours (p<0.001). Mean VAS scores were lower with pregabalin at awakening, 1.18 ± 0.99 versus 1.69 ± 0.73 (P = 0.001), at 30 minutes, 1.44 ± 0.97 versus 2.08 ± 0.98 (p<0.001), at 6 hours, 3.89 ± 1.26 versus 4.48 ± 0.92 (P = 0.002), at 12 hours, 2.93 ± 1.00 versus 3.32 ± 1.12 (P = 0.030), and at 24 hours, 2.14 ± 0.52 versus 2.48 ± 0.86 (P = 0.005).
Conclusion: Preoperative pregabalin was associated with longer postoperative analgesia and lower postoperative pain scores compared with gabapentin.
Keywords: Gabapentin, orthopedic procedures, pain, pregabalin, spinal anesthesia.
Trial Registration: NCT07389551 (clinicaltrials.gov)
Citation: Usman M, Khan A, Ahmad QA, Ayaz M, Mahmood A, Hammad M. Comparison of pregabalin versus gabapentin as pre-emptive analgesic in patients undergoing orthopedic surgeries under spinal anesthesia. Anaesth. pain intensive care. 2026;30(4):411-418. DOI: 10.35975/apic.v30i4.3204
Received: February 09, 2026; Revised: March 08, 2026; Accepted: March 09, 2026
