Gabapentin in the Post-cesarean Pain Management of Buprenorphine Patient

A Randomized, Double-blind, Placebo-controlled Trial of Gabapentin in the Post-cesarean Pain Management of Buprenorphine Patient

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.

Inclusion Criteria:

• singleton, term pregnancy
• currently on buprenorphine maintenance therapy
• scheduled for elective CD under spinal anesthesia

Exclusion Criteria:

• use illicit drugs or relapse during the last trimester of pregnancy
• positive drug screen at the time of delivery
• allergies to any medications used in the study
• taking prescribed gabapentin at the time of admission for CD
• contraindications to neuraxial anesthesia or require general anesthesia for CD
• designated ASA physical status 4 or above