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Statement of the problem: A prospective, randomized clinical trial (case study) over 40 patients undergoing surgical procedures.
Methodology and theoretical orientation: To give Pregabalin (Lyrica) 75 mg 2 h or more before surgery then 75 mg QHS for 3 days postoperative, to be reassessed by acute pain service team if extension needed. Then add Celecoxib (if not contraindicated) 200-400 mg tablet 1 h before surgery then 200 mg BID for 3 days only. Ranitidine 150 mg BID could be added. Surgical site-specific regional analgesia whenever possible, PCA morphine can be used if indicated and as a backup plan for breakthrough pain. Then post-operatively, Pregabalin, Celecoxib, Solpadine 2 tablets Q6 h or TID. Findings: 30 patients came calm pre-op., smooth for GA, RA blocks, other 10 patients little anxious. All patients examined second day; 30 patients had smooth sleep, no pain after regional blocks, needed PCA morphine 1-5 mg (10 patients). Other 10 patients continued only on oral tablets.
Conclusion and significance: the new pre-emptive multimodal analgesic combination is safe and effective postoperative. Lyrica regimen may reduce severity of adverse effects of the opioid. Regular review, follow up of patients postoperative by APS team for 4 days is mandatory.
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