Home›Drug Pipeline› Preoperative pregabalin 150 mg cuts pain and opioid use after laparoscopic cholecystectomy
Preoperative pregabalin 150 mg cuts pain and opioid use after laparoscopic cholecystectomyPregabalin May Reduce Pain After Gallbladder Surgery
medRxivPublished August 23, 2026Study authors: Dewasi, G.; Nagda, P.; Jain, S.DOI ↗Editorial oversight: Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development
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Key Takeaway
Consider a single 150 mg preoperative pregabalin dose to reduce pain and opioid use after laparoscopic cholecystectomy, but watch for sedation.
This is a meta-analysis of randomized controlled trials evaluating the effect of a single 150 mg dose of pregabalin given preoperatively compared with control in patients undergoing laparoscopic cholecystectomy. The primary outcome was 24-hour postoperative pain scores, with secondary outcomes including opioid consumption (fentanyl and tramadol), sedation, postoperative nausea, vomiting, and headache.
Pooled results showed that pregabalin significantly reduced 24-hour postoperative pain scores (SMD = 0.80 lower; 95% CI, 1.42 to 0.18 lower; p = 0.01). Opioid consumption was also reduced: fentanyl consumption was lower (SMD = 1.24 lower; p = 0.002) and tramadol consumption was lower (SMD = 4.21 lower; p = 0.002).
Sedation was slightly increased with pregabalin, but this was not statistically significant. No significant differences were observed for postoperative nausea, vomiting, or headache. The authors report an acceptable safety profile, though specific adverse events were not detailed.
A key limitation is high statistical heterogeneity for pain scores (I-squared = 81%), which suggests variability across studies and limits the precision of the pooled estimate. The certainty of evidence was not reported.
In practice, these findings support the use of a single 150 mg preoperative dose of pregabalin as part of a multimodal analgesic strategy for laparoscopic cholecystectomy. However, clinicians should weigh the modest benefit against the slight increase in sedation and the heterogeneity of the evidence.
How this fits prior evidence
This meta-analysis extends prior coverage on multimodal analgesia by showing that pregabalin, a gabapentinoid, reduces postoperative pain and opioid consumption after laparoscopic cholecystectomy, similar to how dexmedetomidine added to TAP block reduced tramadol consumption and pain scores in cesarean sections. It also complements the finding that serratus anterior plane block reduces opioid consumption and nausea, though pregabalin did not significantly affect nausea. However, given the prior association of gabapentinoids with modestly higher odds of Alzheimer's disease and related dementias, the long-term safety of pregabalin in this setting remains a consideration.
Researchers looked at how a single 150 mg dose of pregabalin given before surgery affects patients undergoing laparoscopic cholecystectomy. This type of surgery is used to remove the gallbladder. The study compared patients who received the medication against those who did not.
The results showed that patients who received the pregabalin had significantly lower pain scores during the first 24 hours after surgery. Additionally, these patients required less fentanyl and tramadol, which are common opioid medications used to manage pain. While there was a slight increase in sedation levels for some patients, this change was not considered statistically significant.
Other side effects like nausea, vomiting, or headaches did not show significant differences between the two groups. The study noted that while the data showed an association, it is only one part of a broader pain management plan. Because the data had high statistical heterogeneity for pain scores, these results should be viewed as supportive evidence rather than a definitive rule.
What this means for you:
A single pre-operative dose of pregabalin may lower post-surgical pain and reduce opioid use after gallbladder surgery.
Common questions
Does pregabalin help with pain after gallbladder surgery?
Yes, the study found that a single 150 mg dose of pregabalin given before surgery significantly reduced pain scores during the first 24 hours. This suggests it can be an effective part of a multi-step plan to manage patient discomfort after a laparoscopic cholecystectomy.
Can this medication reduce the need for opioids?
The study showed that patients who received pregabalin used significantly less fentanyl and tramadol. Specifically, the reduction in tramadol was quite large compared to the control group. This may help patients manage their recovery with fewer opioid medications.
Are there side effects like nausea or sedation?
While some patients experienced a slight increase in sedation, it was not statistically significant. The study also found no significant differences in other common issues like postoperative nausea, vomiting, or headaches for those taking the pregabalin.
Effective postoperative pain control is essential following laparoscopic cholecystectomy, yet the analgesic value of a standardised 150 mg preoperative dose of pregabalin has not been clearly established. This systematic review and meta-analysis synthesised evidence from seven randomised controlled trials published between 2008 and 2025 to evaluate the efficacy and safety of pregabalin when administered before surgery. Four trials reported 24-hour postoperative pain scores, and pooled analysis demonstrated that pregabalin significantly reduced pain compared with control (SMD = 0.80 lower; 95% CI, 1.42 to 0.18 lower; p = 0.01), although statistical heterogeneity was high (I-squared = 81%). Pregabalin also produced notable reductions in opioid consumption, including fentanyl (SMD = 1.24 lower; p = 0.002) and tramadol (SMD = 4.21 lower; p = 0.002), again with considerable variability across studies. Sedation was slightly increased but did not reach statistical significance, and there were no significant differences in postoperative nausea, vomiting, or headache. Sensitivity analyses supported the stability of these findings. Overall, the results indicate that a single 150 mg preoperative dose of pregabalin meaningfully reduces postoperative pain and opioid requirements following laparoscopic cholecystectomy while maintaining an acceptable safety profile, supporting its use as part of a multimodal analgesic strategy.
