Felder Laura, Saccone Gabriele, Scuotto Sergio, Monks David T, Carvalho Jose C A, Zullo Fulvio, Berghella Vincenzo
Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy.
Eur J Obstet Gynecol Reprod Biol. 2019 Feb;233:98-106. doi: 10.1016/j.ejogrb.2018.11.026. Epub 2018 Dec 12.
Cesarean delivery occurs in roughly one third of pregnancies. Effective postoperative pain control is a goal for patients and physicians. Limiting opioid use in this period is important as some percentage of opioid naïve individuals will develop persistent use. Gabapentin is a non-opioid medication that has been used perioperatively to improve postoperative pain and limit opioid requirements. The goal of this study is to determine the efficacy of perioperative gabapentin in improving post cesarean delivery pain control. The following data sources were searched from their inception through October 2018: MEDLINE, Ovid, ClinicalTrials.gov, Sciencedirect, and the Cochrane Library at the CENTRAL Register of Controlled Trials. A systematic review of the literature was performed to include all randomized trials examining the effect of perioperative gabapentin on post cesarean delivery pain control and other postoperative outcomes. The primary outcome was the analgesic effect of gabapentin on post cesarean delivery pain, measured by visual analog scale (VAS; 0-100) or Numerical Rating Scale (NRS; 0-10) on movement 24 hours (h) postoperative. These scores were directly compared by multiplying all NRS scores by a factor of 10. Meta-analysis was performed using the random effects model of DerSimonian and Laird, to produce summary treatment effects in terms of mean difference (MD) with 95% confidence interval (CI). Six placebo controlled trials (n = 645) were identified as relevant and included in the meta-analysis. All studies included only healthy pregnant women (American Society of Anesthesiologist (ASA) physical status I or II) undergoing spinal anesthesia for cesarean delivery at term. Participants were randomized to either 600 mg oral gabapentin or placebo preoperatively and in one study the medications were also continued postoperatively. Pooled data showed that women who received gabapentin prior to cesarean delivery had significantly lower VAS pain scores at 24 h on movement (MD -11.58, 95% CI -23.04 to -0.12). VAS pain scores at other time points at rest or on movement were not significantly different for those who received gabapentin and placebo although there was a general trend toward lower pain scores for women receiving gabapentin. There was no significant between-group difference in use of additional pain medications, supplemental opioids, and maternal or neonatal side effects. There was higher pain control satisfaction at 12 and 24 h in the gabapentin versus placebo groups.
剖宫产在大约三分之一的妊娠中发生。有效的术后疼痛控制是患者和医生的目标。在此期间限制阿片类药物的使用很重要，因为一定比例的未使用过阿片类药物的个体将会发展为持续使用。加巴喷丁是一种非阿片类药物，已在围手术期用于改善术后疼痛并限制阿片类药物的需求。本研究的目的是确定围手术期加巴喷丁在改善剖宫产术后疼痛控制方面的疗效。从数据库创建至2018年10月检索了以下数据来源：MEDLINE、Ovid、ClinicalTrials.gov、Sciencedirect以及CENTRAL对照试验注册库中的Cochrane图书馆。对文献进行了系统评价，纳入所有检验围手术期加巴喷丁对剖宫产术后疼痛控制及其他术后结局影响的随机试验。主要结局是加巴喷丁对剖宫产术后疼痛的镇痛效果，通过术后24小时运动时的视觉模拟量表（VAS；0 - 100）或数字评定量表（NRS；0 - 10）进行测量。通过将所有NRS评分乘以10的系数直接比较这些评分。使用DerSimonian和Laird的随机效应模型进行荟萃分析，以产生具有95%置信区间（CI）的平均差（MD）形式的汇总治疗效果。六项安慰剂对照试验（n = 645）被确定为相关并纳入荟萃分析。所有研究仅纳入足月行剖宫产脊髓麻醉的健康孕妇（美国麻醉医师协会（ASA）身体状况I或II级）。参与者术前随机分为口服600mg加巴喷丁或安慰剂，在一项研究中术后也继续使用这些药物。汇总数据显示，剖宫产术前接受加巴喷丁治疗的女性在术后24小时运动时的VAS疼痛评分显著更低（MD -11.58，95%CI -23.04至 -0.12）。接受加巴喷丁和安慰剂治疗的患者在其他静息或运动时间点的VAS疼痛评分无显著差异，尽管接受加巴喷丁治疗的女性疼痛评分总体呈降低趋势。在额外止痛药物、补充阿片类药物的使用以及母体或新生儿副作用方面，组间无显著差异。加巴喷丁组在12小时和24小时时疼痛控制满意度高于安慰剂组。
