Gabapentin for pain control during same-day dilation and evacuation: A double-blind randomized controlled trial

Abstract

Introduction Scant research evaluates pain management during dilation and evacuation (D&E). Gabapentin has emerged as an effective adjunct for peri-operative pain control. We investigated the effect of gabapentin on pain during D&E. Method We conducted a randomized controlled double-blinded trial among patients undergoing same-day D&E at 14 through 19 weeks gestation under intravenous moderate sedation. Participants were randomized 1:1 to oral gabapentin 600 mg or placebo, administered after misoprostol cervical preparation. Pain was assessed by 100-mm visual analog scale. We assessed satisfaction with pain control, nausea, vomiting, and anxiety using 5-point Likert scales and State Trait Anxiety Inventory. The study was powered to detect a 30% reduction in maximum operative pain (13-mm) assessed five minutes postoperatively. Results We enrolled 126 participants and randomized 61 to gabapentin and 65 to placebo, with study medication administered a mean of 3.5 hours preoperatively (range 1.2–6.2 h). No difference was observed in baseline demographics, parity, or gestational age. Gabapentin was associated with reduced pain after speculum insertion (45 vs 56 mm, p = 0.03) and during uterine aspiration (56 vs 71 mm p = 0.003), compared to placebo. Thirty-minutes post-procedure, the gabapentin group had lower pain (12 vs 23 mm, p=0.008) and higher satisfaction (p = 0.01). Median fentanyl dose was 25 mcg lower in the gabapentin group (75 vs 100 mcg, p = 0.005). Maximum operative pain did not differ between groups (41 vs 49 mm, p = 0.2). Versed dose, nausea, vomiting, and anxiety did not differ between groups. No serious adverse events occurred nor was sedation reversal required. Conclusions The addition of gabapentin to moderate sedation during D&E resulted in reduced intra-operative pain, lower fentanyl dosing, and increased satisfaction with pain control. However, maximum pain reported after the procedure was not different.