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Papers of the Week

Papers: 2 Mar 2019 - 8 Mar 2019

Human Studies, Pharmacology/Drug Development

2019 Aug

J Pain



Perioperative pregabalin and intraoperative lidocaine infusion to reduce persistent neuropathic pain after breast cancer surgery: a multicenter, factorial, randomized controlled pilot trial.


Khan JS, Hodgson N, Choi S, Reid S, Paul JE, Hong N LJ, Holloway C, Busse JW, Gilron I, Buckley ND, McGillion M, Clarke H, Katz J, Mackey S, Avram R, Pohl K, Rao-Melacini P, Devereaux PJ
J Pain. 2019 Aug; 20(8):980-993.
PMID: 30844507.


Persistent post-surgical pain is defined as pain localized to the area of surgery of at least 2-month duration and is unfortunately a common complication after breast cancer surgery. While there is insufficient evidence to support any preventative strategy, prior literature suggests possible efficacy of intravenous lidocaine and perioperative pregabalin in preventing persistent pain after surgery. To determine feasibility of conducting a larger definitive trial, we conducted a multicenter 2-by-2 factorial randomized placebo-controlled pilot trial of 100 female patients undergoing breast cancer surgery. Patients were randomized to receive an intraoperative lidocaine infusion (1.5 mg/kg bolus followed by 2 mg/kg/hr) or placebo and perioperative pregabalin (300 mg preoperatively, 75 mg twice daily for nine days) or placebo. All feasibility criteria were surpassed; recruitment of 100 patients within 42-weeks, follow-up rate of 100%, and study-drug compliance of ≥80%. At 3-months, 53% of patients reported persistent neuropathic pain. While there was no interaction between lidocaine and pregabalin, lidocaine reduced the development of persistent neuropathic pain (43.1% vs 63.3%; RR 0.68, 95% CI 0.47-1.0). Pregabalin did not reduce persistent pain (60% vs 46%; RR 1.3, 95% CI 0.90 to 1.90) and neither pregabalin nor lidocaine impacted acute postoperative pain, opioid consumption, pain interference, or quality of life. Our pilot trial successfully demonstrated feasibility and provided promising data for conducting further trials of intraoperative lidocaine infusions in breast cancer surgeries. Clinical trial number: NCT02240199 Perspectives: This article reports the findings of a pilot randomized controlled trial evaluating the effects of perioperative pregabalin and intraoperative lidocaine infusions in patients undergoing breast cancer surgery. This trial demonstrated feasibility of conducting a larger trial and provided promising data that these interventions may reduce the development of persistent pain.