title: A Perioperative Course of Gabapentin Does Not Produce a Clinically Meaningful Improvement in Analgesia after Cesarean Delivery: A Randomized Controlled Trial.
abstract: BACKGROUND
  Studies examining the efficacy of a single preoperative dose of gabapentin for analgesia after cesarean delivery (CD) have been inconclusive. The authors hypothesized that a perioperative course of gabapentin would improve analgesia after CD.
  
  
  METHODS
  This single-center, randomized, double-blind, placebo-controlled, parallel-group, superiority trial was designed to determine the analgesic efficacy of a perioperative course of gabapentin when added to a multimodal analgesic regimen. Women scheduled for elective CD during spinal anesthesia were randomized to receive a perioperative oral course of either gabapentin (600 mg preoperatively followed by 200 mg every 8 h for 2 days) or placebo. Postoperative pain was measured at 24 and 48 h, at rest and on movement, on a visual analogue scale (VAS, 0 to 100 mm). The primary outcome was pain on movement at 24 h. Neonatal outcomes, opiate consumption, VAS satisfaction (0 to 100 mm), adverse effects, and persistent pain were also assessed.
  
  
  RESULTS
  Baseline characteristics were similar between groups. There was a statistically significant but small reduction in VAS pain score (mean [95% CI]) on "movement" (40 mm [36 to 45] vs. 47 mm [42 to 51]; difference, -7 mm [-13 to 0]; P = 0.047) at 24 h in the gabapentin (n = 100) compared with control group (n = 97). There was more sedation in the gabapentin group at 24 h (55 vs. 39%, P = 0.026) but greater patient VAS satisfaction (87 vs. 77 mm, P = 0.003).
  
  
  CONCLUSIONS
  A perioperative course of gabapentin produces a clinically insignificant improvement in analgesia after CD and is associated with a higher incidence of sedation.
authors.affiliation: From the Departments of Anesthesia (D.T.M., D.W.H., K.D., J.C.A.C.), Paediatrics (V.S.), and Obstetrics and Gynecology (P.B., J.C.A.C.), Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: David T
authors.initials: DT
authors.lastname: Monks
authors.forename: David W
authors.initials: DW
authors.lastname: Hoppe
authors.forename: Kristi
authors.initials: K
authors.lastname: Downey
authors.forename: Vibhuti
authors.initials: V
authors.lastname: Shah
authors.forename: Paul
authors.initials: P
authors.lastname: Bernstein
authors.forename: Jose C A
authors.initials: JC
authors.lastname: Carvalho
mesh_terms: D000328:Adult; D000588:Amines / Q000008:administration & dosage*; D000700:Analgesics / Q000008:administration & dosage*; D002585:Cesarean Section / Q000009:adverse effects*; D003509:Cyclohexanecarboxylic Acids / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D000077206:Gabapentin; D006801:Humans; D010147:Pain Measurement / Q000187:drug effects* / Q000379:methods; D010149:Postoperative Pain / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D019990:Perioperative Care / Q000379:methods*; D011247:Pregnancy; D016896:Treatment Outcome; D005680:gamma-Aminobutyric Acid / Q000008:administration & dosage*
chemical_list: D000588:Amines; D000700:Analgesics; D003509:Cyclohexanecarboxylic Acids; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin