Comparison of Preemptive Oral Gabapentin versus Pregabalin for Postoperative Pain Management after Lower Limb Surgeries under Spinal Anesthesia: A Prospective Randomized Study

Abstract Background and Aim: This study aimed to compare oral Gabapentin and Pregabalin as preemptive analgesics in lower limb surgeries under spinal anesthesia, evaluating their effectiveness in postoperative pain relief and reduction of opioid consumption. Materials and Methods: This prospective, randomized, double-blind study included 140 American Society of Anaesthesiologists physical status I–II patients aged 18–60 years scheduled for elective lower limb surgery under spinal anesthesia. Patients received either oral gabapentin 1200 mg or oral pregabalin 300 mg 1 h before surgery. Postoperative pain was assessed using the Visual Analogue Scale (VAS) for 24 h. Time to first rescue analgesia, total tramadol consumption, sedation score, postoperative nausea and vomiting, and adverse effects were recorded. A P < 0.05 was considered statistically significant. Results: No significant difference in VAS scores was observed between the groups during the first 2 postoperative h. However, from the 3 rd postoperative h onward, VAS scores were significantly lower in the pregabalin group ( P < 0.001). The mean time to first rescue analgesia was significantly longer in the pregabalin group compared to the gabapentin group (395.57 ± 91.17 min vs. 340.29 ± 57.58 min; P < 0.001). Total tramadol consumption during the first 24 h was significantly lower in the pregabalin group (121.71 ± 17.53 mg vs. 153.57 ± 34.47 mg; P < 0.001). The incidence of adverse effects was comparable between the groups. Conclusion: In lower limb surgeries under spinal anesthesia, oral Pregabalin provides better postoperative analgesia than oral Gabapentin, with longer pain relief, reduced opioid requirement, and similar side effects.