What is the recommended dose of Lyrica (pregabalin) for postoperative pain management?

Recommended Dose of Pregabalin for Postoperative Pain Management

For postoperative pain management, pregabalin should be administered at a dose of 150 mg twice daily, starting before surgery and continuing for several days postoperatively. 1, 2

Adult Dosing Recommendations

• Initial pregabalin dose should be 50-75 mg twice daily or 75 mg twice daily, which can be titrated up to 300 mg/day in divided doses 1
• For optimal postoperative pain control, start with 150 mg pregabalin pre-operatively, followed by 75-150 mg twice daily for up to 7 days postoperatively 1, 2
• Maximum recommended dose is 600 mg/day (in divided doses), but higher dosages are not consistently more effective than 300 mg/day and are associated with greater adverse effects 1
• Dosage should be reduced in patients with renal insufficiency 1

Evidence for Efficacy in Postoperative Pain

• Pregabalin 150 mg administered pre-operatively followed by twice-daily dosing postoperatively significantly reduces:

  • Postoperative pain scores for up to 7 days after discharge 2
  • Opioid consumption in the first 24 hours after surgery 3, 2
  • Need for adjunctive opioid medication for 1 week after hospital discharge 2

• The lowest effective daily dose for postoperative analgesia is 225-300 mg/day 4

• Perioperative pregabalin (150 mg twice daily) has been shown to attenuate preoperative anxiety, improve sleep quality, and reduce postoperative pain scores 5

Considerations for Specific Surgical Procedures

• For total hip arthroplasty:

  • Pre-operative pregabalin 150 mg followed by 75 mg twice daily for 7 days postoperatively reduces pain scores and opioid consumption 2
  • When added to a basic analgesic regimen (celecoxib and morphine PCA), pregabalin shows effectiveness in pain management 1

• For total knee arthroplasty:

  • Pregabalin 300 mg before surgery followed by 150-50 mg twice daily for 14 days postoperatively reduces the incidence of chronic neuropathic pain at 3 and 6 months 6

Adverse Effects and Precautions

• Common side effects include:

  • Dizziness and sedation (dose-dependent) 1, 6
  • Visual disturbances (3.29 times higher risk compared to placebo) 3
  • Confusion, particularly on the day of surgery and postoperative day 1 6

• Benefits of pregabalin administration:

  • Reduces opioid-related adverse effects such as vomiting (27% reduction) 3
  • May reduce postoperative nausea and vomiting in patients not receiving anti-PONV prophylaxis 4

• Pregabalin is not recommended as routine medication for all patients due to clinically relevant side effects, particularly in elderly patients 1

Practical Administration Tips

• Start with lower dosages and titrate cautiously to reduce dizziness and sedation 1
• Pregabalin may provide analgesia more quickly than gabapentin because the initial dosage of 150 mg/day has been found efficacious in some trials 1
• In the United States, pregabalin is a Schedule V controlled substance 1
• An adequate trial of treatment with pregabalin's related compound gabapentin can require 2 months or more, suggesting that longer-term therapy may be beneficial in some cases 1