The purpose of this study is to determine whether a perioperative course of gabapentin in parturients on buprenorphine maintenance would improve analgesia after elective cesarean delivery (CD).
Many strategies have been suggested to improve post-CD pain management in parturients on buprenorphine. While effective pain relief can be achieved, women maintained on buprenorphine during pregnancy have been shown to require up to 50% more opioids after CD compared to women with opioid use disorder not on a maintenance regimen. The perioperative use of gabapentin has been shown to reduce pain scores and opioid consumption following a variety of surgeries, ranging from cardiac bypass to total abdominal hysterectomy. The purpose of this study is to determine whether a perioperative course of gabapentin in parturients on buprenorphine maintenance would improve analgesia after elective CD.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Participants will receive Gabapentin 600 mg by mouth one hour prior to scheduled cesarean delivery and 400 mg by mouth every 8 hours post delivery
Participants will receive Placebo with similar appearance to gabapentin by mouth one hour prior to scheduled cesarean delivery and by mouth every 8 hours post delivery
Total opioid use 24 hours after cesarean delivery
Total opioid use tallied in morphine milligram equivalents at 24 hours after cesarean delivery
Time frame: 24 hours after cesarean delivery
Total opioid use at time of hospital discharge after cesarean delivery
Total opioid use tallied in morphine milligram equivalents from the end cesarean delivery to the time of hospital discharge after cesarean delivery
Time frame: From the end of cesarean delivery to the time of hospital discharge after cesarean delivery, approximately 4 days
Pain assessment using 11-point Visual/Verbal Analog (VAS) at rest 4 hours post-partum
Pain assessment using VAS at rest 4 hours post-partum when 0 is no pain and 10 is worst pain
Time frame: 4 hours post-partum
Pain assessment using 11-point Visual/Verbal Analog (VAS) at movement 4 hours post-partum
Pain assessment using VAS at movement 4 hours post-partum when 0 is no pain and 10 is worst pain
Time frame: 4 hours post-partum
Pain assessment using 11-point Visual/Verbal Analog (VAS) at rest 24 hours post-partum
Pain assessment using VAS at rest 24 hours post-partum when 0 is no pain and 10 is worst pain
Time frame: 24 hours post-partum
Pain assessment using 11-point Visual/Verbal Analog (VAS) at movement 24 hours post-partum
Pain assessment using VAS at movement 24 hours post-partum when 0 is no pain and 10 is worst pain
Time frame: 24 hours post-partum
Pain assessment using 11-point Visual/Verbal Analog (VAS) at rest 48 hours post-partum
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Pain assessment using VAS at rest 48 hours post-partum when 0 is no pain and 10 is worst pain
Time frame: 48 hours post-partum
Pain assessment using 11-point Visual/Verbal Analog (VAS) at movement 48 hours post-partum
Pain assessment using VAS at movement 48 hours post-partum when 0 is no pain and 10 is worst pain
Time frame: 48 hours post-partum
Pain assessment using 11-point Visual/Verbal Analog (VAS) at rest 30 days post-partum
Pain assessment using VAS at rest 30 days post-partum when 0 is no pain and 10 is worst pain
Time frame: 30 days post-partum
Pain assessment using 11-point Visual/Verbal Analog (VAS) at movement 30 days post-partum
Pain assessment using VAS at movement 30 days post-partum when 0 is no pain and 10 is worst pain
Time frame: 30 days post-partum
Presence of persistent pain
Presence of persistent pain defined as pain score greater than baseline at 30 days post-partum
Time frame: 30 days post-partum
Return to normal daily function
Return to normal daily function assessed with the Veterans RAND 12-item questionnaire
Time frame: 30 days post-partum