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///2009 Abstract Details
2009 Abstract Details2019-08-03T15:55:31-05:00

Evaluation of oral pregabalin as an adjuvant to epidural analgesia for late termination of pregnancy

Abstract Number: 161
Abstract Type: Original Research

Patricia M Lavand'homme MD, PhD1 ; Fabienne Roelants MD2

Introduction: Late termination of pregnancy (LTOP) represents a new challenge for obstetric anesthesiologists (Benhamou 2007). Pain experienced by the parturients is severe and can remain difficult to relieve despite the use of epidural analgesia. Pregabalin (PGB) used in perioperative conditions shows analgesic and anxiolytic properties. Further, a study previously demonstrated a potentiation of postoperative epidural analgesia by gabapentin, an analog of PGB (Turan et al. 2006). The present study assessed the benefit of adding oral PGB to labor epidural analgesia in patients scheduled for LTOP (medical abortion for severe congenital anomalies or intrauterine death, gestational age > 24 weeks).

Materials and Methods: Healthy women undergoing LTOP under epidural analgesia were included. Just before induction of the standardized procedure, an epidural catheter was placed at L3-L4 level followed by administration of a 3-mL lidocaine-epinephrine test dose and the women were randomly allocated to receive either oral PGB 150 mg/12h or oral prazepam 10 mg/12h until delivery. Oral PGB or prazepam administration began at the induction of the LTOP procedure. When the women felt abdominal pain and requested the activation of epidural analgesia, they were connected to a PCEA device delivering ropivacaine 0.1% with sufentanil 0.25 g/mL, set as a continuous infusion of 5mL/h with bolus dose of 5 mL/30 min. Rescue analgesia was available as needed by administration of bolus dose of 10 mL ropivacaine 0.1% (VAS < 60/100) or 0.2% (VAS > 60/100). Duration of LTOP procedure and epidural infusion, VAS score when activation of PCEA, number of PCEA boluses, number of rescue doses and hourly ropivacaine use during the epidural analgesia utilisation were recorded. Statistical analysis used unpaired t-test, P < 0.05 was considered significant.

Results: Demographic data were similar between both groups: age 326 yrs, weight 657 kg, nulliparas, fetus weigth, duration of LTOP procedure 176 h and PCEA infusion 116 h. Results are expressed in the table as mean (SD) or median (IQR).

Discussion: These preliminary results demonstrate that oral PGB may be a helpful adjuvant to manage pain associated with LTOP, certainly in relation with analgesic and anxiolytic properties of the drug. As previously reported for gabapentin, PGB also potentiates epidural analgesia provided by local anesthetic and opioid combination (Turan et al. 2006).

SOAP 2009