A Perioperative Course of Gabapentin Does Not Produce a Clinically Meaningful Improvement in Analgesia after Cesarean Delivery A Randomized Controlled Trial

作者：Monks David T^*; Hoppe David W; Downey Kristi; Shah Vibhuti; Bernstein Paul; Carvalho Jose C A

来源：Anesthesiology, 2015, 123(2): 320-326.

DOI：10.1097/ALN.0000000000000722

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 (600mg preoperatively followed by 200mg every 8h for 2 days) or placebo. Postoperative pain was measured at 24 and 48h, at rest and on movement, on a visual analogue scale (VAS, 0 to 100mm). The primary outcome was pain on movement at 24h. Neonatal outcomes, opiate consumption, VAS satisfaction (0 to 100mm), 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 (40mm [36 to 45] vs. 47mm [42 to 51]; difference, -7mm [-13 to 0]; P = 0.047) at 24h in the gabapentin (n = 100) compared with control group (n = 97). There was more sedation in the gabapentin group at 24h (55 vs. 39%, P = 0.026) but greater patient VAS satisfaction (87 vs. 77mm, 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.

• 出版日期2015-8