title: Gabapentin improves postcesarean delivery pain management: a randomized, placebo-controlled trial.
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.
  
  
  CONCLUSIONS
  Preoperative gabapentin 600 mg in the setting of multimodal analgesia reduces postcesarean delivery pain and increases maternal satisfaction in comparison with placebo.
authors.affiliation: Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada. moore_albert@hotmail.com
authors.forename: Albert
authors.initials: A
authors.lastname: Moore
authors.forename: Joseph
authors.initials: J
authors.lastname: Costello
authors.forename: Paul
authors.initials: P
authors.lastname: Wieczorek
authors.forename: Vibhuti
authors.initials: V
authors.lastname: Shah
authors.forename: Anna
authors.initials: A
authors.lastname: Taddio
authors.forename: Jose C A
authors.initials: JC
authors.lastname: Carvalho
mesh_terms: D000328:Adult; D000588:Amines / Q000008:administration & dosage* / Q000009:adverse effects; D002585:Cesarean Section / Q000009:adverse effects*; D003509:Cyclohexanecarboxylic Acids / Q000008:administration & dosage* / Q000009:adverse effects; D019468:Disease Management; D004311:Double-Blind Method; D016503:Drug Delivery Systems / Q000379:methods*; D005260:Female; D000077206:Gabapentin; D006801:Humans; D007231:Infant, Newborn; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced / Q000453:epidemiology; D011247:Pregnancy; D005680:gamma-Aminobutyric Acid / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000588:Amines; D003509:Cyclohexanecarboxylic Acids; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin