Limaprost or Pregabalin: Preoperative and Postoperative Medication for Pain due to Lumbar Spinal Stenosis

Pain Pract. 2018 Jun;18(5):625-630. doi: 10.1111/papr.12653. Epub 2017 Dec 15.

Abstract

Purpose: We aimed to evaluate the incidence of (and risk factors for) postoperative pregabalin and/or limaprost to treat persistent numbness and/or pain of the lower extremities after lumbar spinal stenosis (LSS) surgery.

Methods: Medical records of 329 patients (168 men, 161 women; average age 70 years) were retrospectively reviewed for data on the duration of LSS diagnosis; LSS disease; preoperative medication (limaprost, pregabalin, or combined limaprost/pregabalin; duration); symptoms; preoperative/postoperative intermittent claudication (IC); operation type; and postoperative medication and period.

Results: Limaprost, pregabalin, and combined limaprost/pregabalin were prescribed preoperatively for 43%, 7%, and 5% of patients, respectively. At an average of 21 months postoperatively, limaprost, pregabalin, and combined therapy were prescribed in 11%, 8%, 4% of patients, respectively. Medication requirement was significantly lower postoperatively than preoperatively (P < 0.0001). Significant risk factors for required postoperative medication were required preoperative medication (odds ratio [OR] 3.088, 95% confidence interval [CI] 1.679 to 5.681]; postoperative period (OR 1.063, 95% CI 1.031 to 1.096); and postoperative IC (OR 3.868, 95% CI 1.481 to 10.103). A negative impact from postoperative medication was seen in patients who had undergone decompression surgery (OR 0.589, 95% CI 0.377 to 0.918).

Conclusions: Overall, 23% of LSS patients required medication for pain and/or numbness at 21 months postoperatively. Significant factors portending required postoperative medication were preoperative medication, longer postoperative period, and postoperative IC. A negative influence from postoperative medication was seen in patients who had undergone decompression surgery without fusion.

Keywords: conservative treatment; limaprost; lumbar spinal stenosis; postoperative pain; pregabalin.

MeSH terms

  • Aged
  • Alprostadil / analogs & derivatives*
  • Alprostadil / therapeutic use
  • Decompression, Surgical
  • Female
  • Humans
  • Hypesthesia / drug therapy
  • Hypesthesia / etiology
  • Lumbar Vertebrae / surgery
  • Male
  • Middle Aged
  • Pain / drug therapy*
  • Pain / etiology
  • Pain / surgery
  • Postoperative Period
  • Pregabalin / therapeutic use*
  • Retrospective Studies
  • Spinal Stenosis / complications
  • Spinal Stenosis / drug therapy*
  • Spinal Stenosis / surgery

Substances

  • Pregabalin
  • Alprostadil
  • limaprost