Gabapentin for Perioperative Pain Management for Uterine Aspiration: A Randomized Controlled Trial.

Abstract

OBJECTIVE:To evaluate the effect of oral gabapentin in conjunction with usual oral pain management regimens of lorazepam, ibuprofen, oxycodone, and acetaminophen for surgical abortion on pain 5 minutes postprocedure. METHODS:This was a randomized, double-blind, placebo-controlled trial of patients from 6 0/7-14 6/7 weeks of gestation scheduled to undergo surgical abortion at the Duke Family Planning Clinic. Participants were administered 600 mg of oral gabapentin compared with placebo with usual oral pain management. Pain score was assessed using a 100-mm visual analog scale, with the primary outcome being pain score 5 minutes after the procedure. The effect of gabapentin was assessed using a linear regression model controlling for baseline pain. We also measured pain perception 24 hours after the procedure. Secondary outcome measures included anxiety, side effects, and usage of opiate pain medication in the 24-hour postoperative period. RESULTS:Out of 113 women screened for this study; 96 women were recruited, enrolled, and randomized to study treatment arm from August 2016 to June 2018. Pain at 5 minutes after the procedure was similar between the gabapentin and placebo groups ((Equation is included in full-text article.)=3.40; 95% CI -8.20 to 15.0; P=.56). Gabapentin and placebo were well tolerated, with no statistically significant difference in side effects or anxiety levels. Although prescription of opioids after the procedure was not standardized among patients, 73% of women received a short-term prescription for oxycodone. A lower percentage of women in the gabapentin group self-reported taking opioids in the 24 hours postprocedure (18% vs 47%; odds ratio 0.26; 95% CI 0.09-0.75). CONCLUSION:The addition of gabapentin to usual oral pain management regimens with paracervical block did not reduce postoperative pain for patients undergoing outpatient surgical abortion. Although the addition of gabapentin was well tolerated and reduced oral opiate use 24 hours postprocedure, it did not affect the experience of pain during and immediately after the procedure. CLINICAL TRIAL REGISTRATION:ClinicalTrials.gov, NCT02725710.

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Published Version (Please cite this version)

10.1097/aog.0000000000003398

Publication Info

Gray, Beverly A, Jill M Hagey, Donna Crabtree, Clara Wynn, Jeremy M Weber, Carl F Pieper and Lisa B Haddad (2019). Gabapentin for Perioperative Pain Management for Uterine Aspiration: A Randomized Controlled Trial. Obstetrics and gynecology, 134(3). pp. 611–619. 10.1097/aog.0000000000003398 Retrieved from https://hdl.handle.net/10161/19286.

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Scholars@Duke

Gray

Beverly Allen Gray

Associate Professor of Obstetrics and Gynecology
Hagey

Jill M Hagey

Assistant Professor of Obstetrics and Gynecology
Weber

Jeremy Weber

Biostatistician, Senior

Jeremy collaborates with clinicians, residents, and fellows in the Division of Pulmonary, Allergy, and Critical Care Medicine in the Department of Medicine, and the Department of Obstetrics and Gynecology. His research experience involves multilevel modeling, lung transplantation studies, and working with national databases. His statistical interests include longitudinal analysis, observational studies, and survival analysis. 

Pieper

Carl F. Pieper

Professor of Biostatistics & Bioinformatics

Analytic Interests.

1) Issues in the Design of Medical Experiments: I explore the use of reliability/generalizability models in experimental design. In addition to incorporation of reliability, I study powering longitudinal trials with multiple outcomes and substantial missing data using Mixed models.

2) Issues in the Analysis of Repeated Measures Designs & Longitudinal Data: Use of Hierarchical Linear Models (HLM) or Mixed Models in modeling trajectories of multiple variables over time (e.g., physical and cognitive functioning and Blood Pressure). My current work involves methodologies in simultaneous estimation of trajectories for multiple variables within and between domains, modeling co-occuring change.

Areas of Substantive interest: (1) Experimental design and analysis in gerontology and geriatrics, and psychiatry,
(2) Multivariate repeated measures designs,


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