Abstract
Objectives
To assess the analgesic efficacy of preoperative gabapentin among patients undergoing
dilation and evacuation (D&E) with moderate sedation.
Study design
We conducted a randomized, controlled, double-blind trial among patients undergoing
same-day D&E at 14 to 19 weeks gestation under moderate sedation. We randomized participants
1:1 to gabapentin 600 mg or placebo after cervical preparation at least 1 hour prior
to D&E. We assessed pain using a 100-mm visual analog scale before, during, and after
the procedure. The primary outcome was postoperative recall of maximum procedural
pain with a 13-mm a priori threshold for clinical significance. We standardized initial
fentanyl and midazolam dosing. We assessed satisfaction with pain control, nausea,
and vomiting via Likert scales and anxiety using a validated instrument.
Results
We enrolled 126 participants and randomized 61 to gabapentin and 65 to placebo, with
study medication administered a mean of 211 (SD 64) minutes preoperatively. Recall
of maximum pain was 41 mm for gabapentin and 49 mm for placebo (p = 0.24). Gabapentin resulted in reduced pain during uterine aspiration (56 vs 71
mm, p= 0.003) compared to placebo, but not for any other time points. The gabapentin group
had higher satisfaction (78% vs 65% very or somewhat satisfied, p= 0.01). Median fentanyl dose was lower in the gabapentin group (75 vs 100 mcg, p = 0.005). Midazolam dose, nausea, vomiting, and anxiety did not differ between groups.
No serious adverse events occurred in the gabapentin group. Sedation reversal was
not required.
Conclusions
The addition of gabapentin to moderate sedation during D&E did not result in lower
maximum recalled procedural pain. Gabapentin resulted in reduced intra-operative pain
during uterine aspiration and increased satisfaction with pain control.
Implications
Gabapentin reduces intraoperative pain and improves satisfaction with pain management
when administered prior to second-trimester surgical abortion and may be considered
as an adjunct to intravenous sedation. Moderate sedation may impair assessment and
recall of pain. Additional research is needed to identify the most effective pain
management regimens for D&E.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ContraceptionAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Abortion incidence and service availability in the United States.Perspect Sex Reprod Health 2017. 2014; 49https://doi.org/10.1363/psrh.12015
- Abortion surveillance — United States.MMWR Surveill Summ 2016. 2013; 65: 1-44https://doi.org/10.15585/mmwr.ss6512a1
- Pain control in first-trimester and second-trimester medical termination of pregnancy: A systematic review.Contraception. 2011; 83: 116-126https://doi.org/10.1016/j.contraception.2010.07.014
- The SFP research priority setting process.Contraception. 2015; 92: 282-288https://doi.org/10.1016/j.contraception.2015.08.001
Food and Drug Administration. FDA approved labeling: Neurontin ® (gabapentin) capsules Neurontin ® (gabapentin) tablets Neurontin ® (gabapentin) oral solution. FDA Approv Labeling 2011. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/020235s064_020882s047_021129s046lbl.pdf (accessed February 19, 2022).
- Perioperative gabapentinoids.Anesthesiology. 2013; 119: 1215-1221https://doi.org/10.1097/ALN.0b013e3182a9a896
- A systematic review and meta-regression analysis of prophylactic gabapentin for postoperative pain.Anaesthesia. 2015; 70: 1186-1204https://doi.org/10.1111/anae.13179
- Perioperative use of gabapentinoids for the management of postoperative acute paina systematic review and meta-analysis.Anesthesiology. 2020; 133: 265-279https://doi.org/10.1097/ALN.0000000000003428
- Single dose of preoperative analgesia with gabapentin (600 mg) is safe and effective in monitored anesthesia care for nasal surgery.Eur Arch Oto-Rhino-Laryngology. 2010; 267: 731-736https://doi.org/10.1007/s00405-009-1175-5
- Gabapentin as an adjunct to paracervical block for perioperative pain management for first-trimester uterine aspiration: a randomized controlled trial.Am J Obstet Gynecol. 2020; S0002-9378: 30626-30628https://doi.org/10.1016/j.ajog.2020.06.011
- Gabapentin for perioperative pain management for uterine aspiration: A randomized controlled trial.Obstet Gynecol. 2019; 134: 611-619https://doi.org/10.1097/AOG.0000000000003398
- Measures of anxiety: State-Trait Anxiety Inventory (STAI), Beck Anxiety Inventory (BAI), and Hospital Anxiety and Depression Scale-Anxiety (HADS-A).Arthritis Care Res (Hoboken). 2011; 63: S467-S472https://doi.org/10.1002/acr.20561
- Some norms and reliability data for the State–Trait Anxiety Inventory and the Zung Self-Rating Depression scale.Br J Clin Psychol. 1983; 22: 245-249
- Oral compared with intravenous sedation for first-trimester surgical abortion: A randomized controlled trial.Obstet Gynecol. 2009; 113: 276-283https://doi.org/10.1097/AOG.0b013e3181938758
- Pain management for medical and surgical termination of pregnancy between 13 and 24 weeks of gestation: A systematic review.BJOG An Int J Obstet Gynaecol. 2020; 127: 1348-1357https://doi.org/10.1111/1471-0528.16212
- Second-trimester surgical abortion practices in the United States.Contraception. 2018; 98: 95-99https://doi.org/10.1016/J.CONTRACEPTION.2018.04.004
- Perioperative gabapentinoids choice of agent, dose, timing, and effects on chronic postsurgical pain.Anesthesiology. 2013; 119: 1215-1221https://doi.org/10.1097/ALN.0b013e3182a9a896
Article info
Publication history
Published online: October 11, 2022
Accepted:
September 23,
2022
Received in revised form:
September 18,
2022
Received:
November 24,
2021
Footnotes
☆Conflicts of interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article.
☆☆Funding: This work was supported by the Society of Family Planning [grant #SFPRF17-27]. The funding organization had no role in the study design; collection, analysis, and interpretation of data; writing of the report; the decision to submit the report for publication.
Identification
Copyright
© 2022 Published by Elsevier Inc.
