///2009 Abstract Details
2009 Abstract Details2019-08-03T15:55:31-06:00

Gabapentin improves the efficacy of a multimodal analgesic regimen for post-cesarean delivery pain: A randomized placebo-controlled trial.

Abstract Number: 186
Abstract Type: Original Research

Albert Moore MD1 ; Joseph F Costello MD2; Paul M Wieczorek MD3; Vibhuti Shah MD4; Anna Taddio PhD5; Carvalho C.A. Jose MD, PhD6

Background: Postoperative pain is the worst fear of women undergoing cesarean delivery (1), and can develop into chronic pain (2). Gabapentin prevents and treats acute and chronic postoperative pain (3), and its use during pregnancy and lactation is not deleterious to neonates (4,5). This study assessed the efficacy of gabapentin as part of a multimodal analgesic regimen for post-cesarean delivery pain that included intrathecal opioids.

Methods: Patients undergoing cesarean delivery were randomized to oral gabapentin 600mg or placebo 1 hour preoperatively. Spinal anesthesia was achieved with 1.6ml of 0.75% hyperbaric bupivacaine, 10g of fentanyl and 100g of preservative free morphine. Postoperative pain was controlled with 30mg of ketorolac IV and 1g of acetaminophen PR at the end of surgery, then 50mg diclofenac PO q8h and 1g acetaminophen PO q6h standing, and morphine or hydromorphone PRN for 72 hours. At 6, 12, 24, and 48 hours after completion of the spinal, patients were assesed for pain at rest and on movement using a visual analog scale (VAS), as well as for narcotic consumption, and any related side effects. Neonatal Apgar scores, arterial cord blood gases, and need for NICU admission were assessed. Gabapentin concentrations in maternal and umbilical cord blood were measured in the first 26 patients.

Results: Forty-four patients were included. One patient who received IV dimenhydrinate was unblinded because of excessive sedation and was excluded. Pain on movement at 24 h was significantly less in the gabapentin group(Table 1). There was no difference in opiod requirements or the incidence of side effects between the groups. There was no difference in neonatal interventions, Apgar scores or umbilical artery blood gases between groups. Mean gabapentin plasma levels at delivery were: maternal 7.5(S.D. 3.7), umbilical vein 6.4(S.D. 3.3), and umbilical artery 5.1(S.D. 3.1) mol l-1. The mean UV/MV ratio was 0.86(S.D. 0.12).

Conclusion: Gabapentin 600 mg given orally before cesarean delivery significantly reduces postoperative pain, with no increase in maternal or neonatal adverse events. Further studies in a larger population are warranted to establish the safety of this promising adjunct to a multimodal regimen inclusive of intrathecal opioids.

References 1. Anesth Analg 2005; 101:1182-1187; 2. Acta Anaesthesiol Scand 2004; 48:111-116; 3. Anesth Analg 2007; 104:1545-56; 4. Epilepsia 2005; 46: 1621-1624; 5. Epilepsy & Behaviour 20.

SOAP 2009