Randomized controlled trial of two oral regimens of gabapentin versus placebo in patients for Cesarean section under spinal anesthesia regarding postoperative pain, sedation, nausea and vomiting
Background and aim: Pain after Cesarean delivery parturients is the most common postoperative complaint, and gabapentin has been shown to reduce acute postoperative pain but with little experience in parturient. Methods: After approval from the ethical committee in Kasr Al Aini University Hospital, forty-five consenting women aging 20-40yrs old ASA physical status I or II, with uncomplicated pregnancies scheduled to undergo elective Cesarean section delivery under spinal anesthesia were randomly allocated into three equal groups who received 600mg gabapentin G600, 900mg gabapentin G900, and control group GC. The study medication was given orally one hour before the anticipated time of the surgical incision, and data measured include, the time of first rescue of analgesia, the total duration of analgesia, the incidence of post-operative nausea and vomiting (PONV), the level of sedation, and the Neonatal APGAR score at 1 and 5 min. Results: The time for first rescue of analgesia was comparatively shorter in patients of group GC as compared to G600 and G900 groups (P value=0.001). Total analgesic requirement of pethidine in first 24h was significantly lower in groups G600 and G900 as compared to group GC (P value=0.000) and we found that there was statistically significant increase in the sedation scores of the patients in the G900 group as compared to GC group and G600 group. By comparing the presence of nausea and vomiting in the two gabapentin groups with the control group as a reference value, and with each other in the postoperative periods, we found that there was statistically significant decrease in the nausea score in the G900 group as compared to groups G600 and GC with p value (0.06 and 0.4) respectively. Conclusion: Gabapentin 900mg was more effective than 600mg in reducing post Cesarean section pain, opioid consumption, nausea, and vomiting.
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