Combination of Dexamethasone and Pregabalin for Postoperative Pain After Laminectomy: A Randomized Controlled Trial

Purpose Multimodal analgesia is standard for post-laminectomy pain. This study evaluated two intravenous dexamethasone doses, with or without oral pregabalin, within this framework. Methods In this randomized, double-blind, placebo-controlled trial, 800 adult patients undergoing elective 2–3 level lumbar laminectomy were allocated to: Group A (8 mg IV dexamethasone + 150 mg oral pregabalin), Group B (8 mg IV dexamethasone + oral placebo), Group C (4 mg IV dexamethasone + 150 mg oral pregabalin), or Group D (4 mg IV dexamethasone + oral placebo). Drugs were given preemptively. Primary outcome was pain scores (Visual Analogue Scale, VAS) over 24 hours. Secondary outcomes included 24-hour opioid consumption (morphine equivalents), time to first rescue analgesia, hemodynamics, and adverse events. Results All patients completed the protocol. Statistically significant differences in VAS scores were observed among groups at all time points (p < 0.001), with Group A reporting the lowest scores. Twenty-four-hour opioid consumption was also significantly different (p < 0.001), being lowest in Group A. A formal factorial analysis indicated a statistically significant interaction effect (p = 0.012) between the higher dexamethasone dose and pregabalin. Sedation/dizziness was more frequent in pregabalin groups (A: 22.5%; C: 20.0%) versus placebo groups (B & D: 5.0% each; p < 0.001). No significant differences in surgical site infections or hyperglycemia were noted. Conclusion In a selected cohort of patients undergoing elective laminectomy, preemptive administration of 8 mg IV dexamethasone combined with 150 mg oral pregabalin was associated with statistically significant reductions in pain scores and opioid requirements over 24 hours compared to lower doses or monotherapy, alongside greater hemodynamic stability but increased neurosedative effects. This combination represents a potential option within multimodal analgesia protocols for spinal surgery, though its generalizability to broader patient populations requires further study. Level of evidence: 1