A randomized trial evaluating pregabalin vs gabapentin on reducing opioid usage in patients with acute trauma injuries.

OBJECTIVE: Pregabalin and gabapentin have shown efficacy in reducing pain and opioid use, but limited data exist on their effectiveness in acute trauma patients. This study aimed to evaluate their impact on pain relief and opioid consumption in this population. DESIGN: A prospective, unblinded, randomized trial. SETTING: This study was conducted at a tertiary, academic Level I trauma center located in the southeastern region of the United States between 2021 and 2024. PATIENTS: A total of 101 patients were included in the study and randomized into three groups: pregabalin, gabapentin, and a control group. INTERVENTIONS: The pregabalin group received 50 mg of pregabalin, the gabapentin group received 300 mg of gabapentin, and the control group received neither. Drugs were administered every 8 or 12 hours, based on patients' creatinine -clearance. MAIN OUTCOME MEASURE: Patients' daily opioid intake during enrollment. RESULTS: Total opioid and nonopioid analgesic use was similar across all groups. Median total opioid use was 69.5 morphine milligram equivalent (MME), 81.0 MME, and 66.3 MME, and nonopioid use was 5,362.5 mg, 6,600.0 mg, and 7,225.0 mg in the pregabalin, gabapentin, and neither groups, respectively. Likewise, average daily use of both opioid and nonopioid analgesics was comparable across groups. Median average daily pain scores ranged from 6.2 to 6.4, with no significant differences observed among the groups. CONCLUSIONS: Multimodal pain management in hospitalized trauma patients needs to be considered, especially in areas known for opioid misuse. Nonopioid analgesics aside from gabapentinoids may serve as an appropriate approach to manage pain in these individuals.