Safety and Efficacy of Pregabalin in Pain Control after Tonsillectomy: A Systematic Review and Meta-analysis of Randomised Controlled Trials

Abstract Background: Tonsillectomy is a common procedure performed for conditions like recurrent tonsillitis, obstructive sleep apnoea and peritonsillar abscesses. Despite its benefits, post-tonsillectomy pain remains a significant issue, leading to delayed recovery, poor oral intake and increased opioid consumption. Pregabalin, a neuromodulator that acts on voltage-gated calcium channels, has been studied for its potential in reducing postoperative pain. Aim: This systematic review and meta-analysis aimed to assess the efficacy and safety of pregabalin in reducing post-tonsillectomy pain, opioid consumption and side effects. Materials and Methods: Following preferred reporting items for systematic reviews and meta-analyses guidelines, we conducted a comprehensive search of PubMed, Scopus, Web of Science and Cochrane Library databases for randomised controlled trials (RCTs) comparing pregabalin to a control group for post-tonsillectomy pain management. The primary outcomes were visual analogue scale pain scores and total fentanyl consumption, while secondary outcomes included operation time, drowsiness and vomiting. Data were pooled using a random-effects model, and heterogeneity was assessed using the I 2 statistic. Results: Five RCTs with 310 patients met the inclusion criteria. Pregabalin significantly reduced postoperative pain (mean difference [MD]: −1.94, 95% CI: −2.36–−1.51, P < 0.00001) and opioid consumption (MD: −43.69 μg, 95% CI: −51.43–−35.95, P < 0.0001). There was no significant difference in operation time (MD: −0.62 min, P = 0.68), drowsiness (odds ratio [OR]: 0.38, P = 0.37) or vomiting (OR: 0.85, P = 0.69). Conclusion: Pregabalin is effective in reducing post-tonsillectomy pain and opioid consumption without increasing adverse effects. Further large-scale studies are needed to confirm these findings and optimise dosing strategies.