Effect of gabapentin on postoperative pain control after a cesarean delivery: a pilot randomized controlled trial

Abstract

Background: Opioid dependence has risen dramatically and is becoming more common in pregnant women. Finding adjunct methods to reduce the need for postoperative opioid pain medications is needed. The objective of this pilot trial was to evaluate if administration of gabapentin after cesarean delivery would decrease postoperative opiate requirements and pain scores.Methods: This was a pilot, triple-blind, placebo-controlled, randomized trial. Women undergoing a non-emergent repeat cesarean delivery who only planned to bottle feed their infants were recruited. Gabapentin (600mg) or placebo was administered every 8 hours for the first 48 hours after a cesarean delivery. The primary outcome was opiate consumption in the acute postoperative period. All pain medications received during that time frame were converted to morphine equivalents for statistical analysis. The secondary outcomes assessed included pain scores and adverse events.Results: Over 15 months, 327 women were screened, 33 were found eligible, 13 women were consented and randomized as follows: 3 to gabapentin, 10 to placebo. One woman was withdrawn after having to be converted to general anesthesia during her cesarean delivery. There was a significant reduction in total morphine equivalent consumption at 48 hours (placebo vs. gabapentin: total during first 48 hours-22.6 ± 14.1 vs. 8.9 ± 2.5, p=0.02). The mean pain scores at rest and with movement had no statistically significant differences. There was also no difference in the side effects experienced between the two groups. Conclusion:In this small pilot study, the use of gabapentin in the acute postoperative period following a cesarean delivery appears to reduce opiate consumption without significantly altering VAS pain scores or incidence of adverse side effects.