Abstract
Purpose
Pain after cesarean delivery is a leading cause of chronic pain and there are many attempts to reduce it without total success. Gabapentin is effective in reducing acute and chronic pain with little experience in parturient. The purpose of this study is to compare the effect of pre-emptive gabapentin with intrathecal fentanyl on reducing postoperative pain and morphine consumption in cesarean surgery.
Methods
Seventy-eight primiparous women who scheduled for non-emergency cesarean delivery were enrolled in the study and separated into two groups. The control group received 12.5 mg of heavy bupivacaine 0.5 % plus 10 μg of fentanyl intrathecally and the case group received 300 mg of gabapentin orally 2 h before surgery and 12.5 mg of heavy bupivacaine 0.5 % intrathecally. Data collection including blood pressure, heart rate, neonate sedation, Apgar score, visual analogous scale at several hours, at first, need to analgesic postoperatively.
Results
In the fentanyl group, the need for analgesic drug was earlier, total dose of morphine in 24 h and patient satisfaction was higher than the gabapentin group. The mean visual analogous scale at several hours postoperatively in the fentanyl groups was significantly higher than the gabapentin groups (P = 0.001).
Conclusion
Preemptive use of gabapentin is a safe and effective way to reduce postoperative pain and morphine consumption in parturients after cesarean surgery.
Similar content being viewed by others
References
Eltzschig HK, Lieberman ES, Camann WR (2003) Regional anesthesia and analgesia for labor and delivery. N Engl J Med 23(348):319–332
Halpern SH, Walsh VL (2001) Multimodal therapy for post-cesarean delivery pain. Reg Anesth Pain Med 26:298–300
Miovech SM, Knapp H, Borucki L, Roncoli M, Arnold L, Brooten D (1994) Major concerns of women after cesarean delivery. J Obstet Gynecol Neonatal Nurs 23:53–59
Fukushima S, Takenami T, Yagishita S, Nara Y, Hoka S, Okamoto H (2011) Neurotoxicity of intrathecally administered fentanyl in a rat spinal model. Pain Med 12:717–725. doi:10.1111/j.1526-4637.2011.01084.x
Etches R, Sandler A, Daley M (1989) Respiratory depression and spinal opioids. Can J Anaesth 36:165–185
Chaney M (1995) Side effects of intrathecal and epidural opioids. Can J Anaesth 42:891–903
Rorarius MG, Mennander S, Suominen P, Rintala S, Puura A, Pirhonen R, Salmelin R, Haanpää M, Kujansuu E, Yli-Hankala A (2004) Gabapentin for the prevention of postoperative pain after vaginal hysterectomy. Pain 110:175–181
Eckhardt K, Ammon S, Hofmann U, Riebe A, Gugeler N, Mikus G (2000) Gabapentin enhances the analgesic effect of morphine in healthy volunteers. Anesth Analg 91:185–191
Montouris G (2003) Gabapentin exposure in human pregnancy: results from the gabapentin pregnancy registry. Epilepsy Behav 4:310–317
Ohman I, Vitols S, Tomson T (2005) Pharmacokinetics of gabapentin during delivery, in the neonatal period, and lactation: does a fetal accumulation occur during pregnancy? Epilepsia 46:1621–1624
Kainu JP, Sarvela J, Tiippana E, Halmesmäki E, Korttila KT (2010) Persistent pain after caesarean section and vaginal birth: a cohort study. Int J Obstet Anesth 19:4–9. doi:10.1016/j.ijoa.2009.03.013
Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O’Neal PV, Keane KA, Tesoro EP, Elswick RK (2002) The Richmond agitation–sedation scale. Am J Respir Crit Care Med 15(166):1338–1344
Wilson E, David A, MacKenzie N, Grant IS (1990) Sedation during spinal anaesthesia: comparison of propofol and midazolam. Br J Anaesth 64:48–52
Christensen M, Thomson V, Letson GW (2008) Evaluating the reach of universal newborn hearing screening in Colorado. Am J Prev Med 35(6):594–597. doi:10.1016/j.amepre.2008.09.007
Dahlgren G, Hultstrand C, Jakobsson J, Norman M, Eriksson EW, Martin H (1997) Intrathecal sufentanil, fentanyl, or placebo added to bupivacaine for cesarean section. Anesth Analg 85:1288–1293
Moore A, Costello J, Wieczorek P, Shah V, Taddio A, Carvalho JCA (2011) Gabapentin improves postcesarean delivery pain management: a randomized, placebo-controlled trial. Anesth Analg 112:167–173. doi:10.1213/ANE.0b013e3181fdf5ee
Ajori L, Nazari L, Mazloomfard MM, Amiri Z (2012) Effects of gabapentin on postoperative pain, nausea and vomiting after abdominal hysterectomy: a double blind randomized clinical trial. Arch Gynecol Obstet 285:677–682. doi:10.1007/s00404-011-2023-6
Dirks J, Fredensborg BB, Christensen D, Fomsgaard JS, Flyger H, Dahl JB (2002) A randomized study of the effects of single-dose gabapentin versus placebo on postoperative pain and morphine consumption after mastectomy. Anesthesiology 97:560–564
Short J, Downey K, Bernstein P, Shah V, Carvalho JC (2012) A single preoperative dose of gabapentin does not improve postcesarean delivery pain management: a randomized, double-blind, placebo-controlled dose-finding trial. Anesth Analg 115:1336–1342. doi:10.1213/ANE.0b013e31826ac3b9
Conflict of interest
Not declared.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Najafi Anaraki, A., Mirzaei, K. The effect of gabapentin versus intrathecal fentanyl on postoperative pain and morphine consumption in cesarean delivery: a prospective, randomized, double-blind study. Arch Gynecol Obstet 290, 47–52 (2014). https://doi.org/10.1007/s00404-014-3152-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-014-3152-5