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A perioperative course of gabapentin improves pain relief after cesarean delivery: a randomized controlled trial
Abstract Number: GM-01
Abstract Type: Original Research
Introduction: One small RCT suggested a benefit from a preoperative dose of 600 mg gabapentin in reducing postcesarean pain in the context of spinal anesthesia and a multi-modal analgesic regimen inclusive of intrathecal morphine (1). A subsequent RCT, designed to find the optimal dose, cast some doubt on this finding and suggested that a larger study was required (2). Based on these trials and following a trend in the literature, we hypothesized that a perioperative course of gabapentin would reduce postcesarean pain.
Methods: Healthy women scheduled for elective cesarean delivery performed under spinal anesthesia with 1.6-1.8 ml of 0.75% hyperbaric bupivacaine, 10 mcg fentanyl and 100 mcg morphine were randomized to receive a perioperative course of either gabapentin or placebo. The dosing in the treatment group consisted of a preoperative dose of 600 mg gabapentin followed by a 48 hour postoperative course of 200 mg three times a day. Both groups received a standardized regimen of regular oral acetaminophen and diclofenac. Parenteral morphine was administered as required. Postoperative pain, at rest and on movement, and satisfaction were measured on a visual analogue scale (VAS 0-100 mm) along with opioid consumption and side effects at 24 and 48 hours after the incision. Neonatal outcomes were APGAR scores, need for resuscitative support, umbilical blood gases and breast feeding difficulties. Telephone interviews were conducted at 2 and 6 weeks to assess for persistent pain. The primary outcome was pain on movement at 48 hours postoperatively.
Results: 204 women were randomized, 17 were excluded and 187 were analyzed. There was no difference in VAS pain scores on movement at 48 hours between groups (mean [SD]): gabapentin 33.6 [21.2] vs. placebo 35.6 [24.5], p=0.54). However, there was a significant reduction in VAS pain scores at rest (12.2 [16.3] vs. 18.3 [17.6], p=0.015) and on movement (39.0 [21.6] vs. 46.9 [23.1], p=0.016), and greater satisfaction scores (mean [SD]: 87.9 [15.8] vs. 77.5 [22.2], p=0.003) at 24 hours in the gabapentin group. The number(%) of patients receiving additional parenteral opioids in the first 24 hours was also significantly lower in the gabapentin group (17 [17.7] vs. 29 [31.9], p=0.025). There was a significant increase in the incidence of sedation in the first 24 hours (55.2% vs. 39.6%, p=0.032) in the gabapentin group. There was no difference in neonatal outcomes between the groups. There was also no difference in the incidence of pain at 2 and 6 weeks postpartum (36.1% vs. 49.4% and 5.6% vs. 4.2% in the gabapentin and placebo groups, respectively).
Discussion: A perioperative course of gabapentin reduces pain and opioid consumption in the first 24 hours post cesarean delivery. Although an increase in sedation is observed with the use of gabapentin, patient satisfaction with pain management is higher.
References:1) Anesth Analg 2011;112:167-73;2) Anesth Analg 2012;115:1336