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Gabapentin improves postcesarean delivery pain management: a randomized, placebo-controlled trial.
Anesth Analg. 2011 Jan; 112(1):167-73.A&A

Abstract

BACKGROUND

Gabapentin is effective for preventing and treating acute and chronic postoperative pain; however, it has not been described for use in cesarean delivery. We hypothesized that preoperative gabapentin would reduce postcesarean delivery pain.

METHODS

Women undergoing scheduled cesarean delivery were randomized to receive preoperative gabapentin 600 mg, or placebo. Spinal anesthesia was achieved with 0.75% hyperbaric bupivacaine 12 mg, fentanyl 10 μg, and morphine 100 μg. Postoperative analgesia was initiated with intraoperative ketorolac and acetaminophen, and continued with postoperative diclofenac, acetaminophen, and morphine. Patients were assessed at 6, 12, 24, and 48 hours after spinal anesthesia for pain at rest and on movement using a visual analog scale (0 to 100 mm), satisfaction, opioid consumption, and side effects. Neonatal interventions, Apgar scores, umbilical artery blood gases, and breastfeeding difficulties were assessed. Chronic pain was assessed 3 months after delivery. Maternal and umbilical vein gabapentin plasma concentrations were measured in a subgroup of patients. Mixed-model analysis was used to compare the primary outcome of visual analog scale pain scores at 24 hours between groups.

RESULTS

Forty-six patients were randomized, and 2 were excluded from analysis. The mean (95% confidence interval, CI) pain scores on movement at 24 hours were 21 mm (CI = 13-28) in the gabapentin and 41 mm (CI = 31-50) in the placebo group (P = 0.001). Maternal satisfaction was higher in the gabapentin group. There was no difference in opioid consumption. Severe maternal sedation was more common in the gabapentin group (19% vs. 0%, P = 0.04). There was no difference in neonatal Apgar scores, interventions, or umbilical artery pH. The mean (SD) maternal vein:umbilical vein plasma gabapentin ratio was 0.86 (0.12). The incidence of pain at 3 months was similar in both groups.

CONCLUSION

Preoperative gabapentin 600 mg in the setting of multimodal analgesia reduces postcesarean delivery pain and increases maternal satisfaction in comparison with placebo.

Authors+Show Affiliations

Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada. moore_albert@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

21081764

Citation

Moore, Albert, et al. "Gabapentin Improves Postcesarean Delivery Pain Management: a Randomized, Placebo-controlled Trial." Anesthesia and Analgesia, vol. 112, no. 1, 2011, pp. 167-73.
Moore A, Costello J, Wieczorek P, et al. Gabapentin improves postcesarean delivery pain management: a randomized, placebo-controlled trial. Anesth Analg. 2011;112(1):167-73.
Moore, A., Costello, J., Wieczorek, P., Shah, V., Taddio, A., & Carvalho, J. C. (2011). Gabapentin improves postcesarean delivery pain management: a randomized, placebo-controlled trial. Anesthesia and Analgesia, 112(1), 167-73. https://doi.org/10.1213/ANE.0b013e3181fdf5ee
Moore A, et al. Gabapentin Improves Postcesarean Delivery Pain Management: a Randomized, Placebo-controlled Trial. Anesth Analg. 2011;112(1):167-73. PubMed PMID: 21081764.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Gabapentin improves postcesarean delivery pain management: a randomized, placebo-controlled trial. AU - Moore,Albert, AU - Costello,Joseph, AU - Wieczorek,Paul, AU - Shah,Vibhuti, AU - Taddio,Anna, AU - Carvalho,Jose C A, Y1 - 2010/11/16/ PY - 2010/11/18/entrez PY - 2010/11/18/pubmed PY - 2011/1/21/medline SP - 167 EP - 73 JF - Anesthesia and analgesia JO - Anesth Analg VL - 112 IS - 1 N2 - BACKGROUND: Gabapentin is effective for preventing and treating acute and chronic postoperative pain; however, it has not been described for use in cesarean delivery. We hypothesized that preoperative gabapentin would reduce postcesarean delivery pain. METHODS: Women undergoing scheduled cesarean delivery were randomized to receive preoperative gabapentin 600 mg, or placebo. Spinal anesthesia was achieved with 0.75% hyperbaric bupivacaine 12 mg, fentanyl 10 μg, and morphine 100 μg. Postoperative analgesia was initiated with intraoperative ketorolac and acetaminophen, and continued with postoperative diclofenac, acetaminophen, and morphine. Patients were assessed at 6, 12, 24, and 48 hours after spinal anesthesia for pain at rest and on movement using a visual analog scale (0 to 100 mm), satisfaction, opioid consumption, and side effects. Neonatal interventions, Apgar scores, umbilical artery blood gases, and breastfeeding difficulties were assessed. Chronic pain was assessed 3 months after delivery. Maternal and umbilical vein gabapentin plasma concentrations were measured in a subgroup of patients. Mixed-model analysis was used to compare the primary outcome of visual analog scale pain scores at 24 hours between groups. RESULTS: Forty-six patients were randomized, and 2 were excluded from analysis. The mean (95% confidence interval, CI) pain scores on movement at 24 hours were 21 mm (CI = 13-28) in the gabapentin and 41 mm (CI = 31-50) in the placebo group (P = 0.001). Maternal satisfaction was higher in the gabapentin group. There was no difference in opioid consumption. Severe maternal sedation was more common in the gabapentin group (19% vs. 0%, P = 0.04). There was no difference in neonatal Apgar scores, interventions, or umbilical artery pH. The mean (SD) maternal vein:umbilical vein plasma gabapentin ratio was 0.86 (0.12). The incidence of pain at 3 months was similar in both groups. CONCLUSION: Preoperative gabapentin 600 mg in the setting of multimodal analgesia reduces postcesarean delivery pain and increases maternal satisfaction in comparison with placebo. SN - 1526-7598 UR - https://www.unboundmedicine.com/medline/citation/21081764/Gabapentin_improves_postcesarean_delivery_pain_management:_a_randomized_placebo_controlled_trial_ L2 - https://doi.org/10.1213/ANE.0b013e3181fdf5ee DB - PRIME DP - Unbound Medicine ER -