Can Gabapentin Decrease Opioid Consumption in Chronic Buprenorphine Users After Cesarean Delivery?

Opioid consumption during the first 72 hours after cesarean delivery (CD) was not reduced with the inclusion of gabapentin in a multimodal analgesic regimen among women who were chronic buprenorphine users. These findings, from a retrospective cohort study, were published in the Journal of Clinical Anesthesia.

Electronic medical records from women (N=214) who were chronic buprenorphine users and underwent CD at the Vanderbilt University Medical Center in Nashville, Tennessee between 2007 and 2017 were retrospectively reviewed. Opioid consumption during the first 72 hours post procedure was compared between women who received ≥1 dose gabapentin (n=64) within 24 hours of CD compared with those who did not (n=150).

The gabapentin and control cohorts were aged 29±5 and 29±5 years, BMI was 30±6 and 30±7 kg/m², 36% and 45% had no previous CD, 83% and 91% were current smokers, 64% and 62% had a psychiatric comorbidity, median buprenorphine pre-admission daily dose was 16 (interquartile range [IQR], 16-20) and 16 (IQR, 16-20) mg, and 53% and 53% received spinal anesthesia, respectively.

Of note, 93% of the study population gave birth during the last 5 years of the study period.

Gabapentin dose ranged from 100-1200 mg/dose with a median dose of 300 mg. Among neuraxial anesthesia recipients, 94% received morphine with a median dose of 200 (range, 200-500) mg. Epidural doses ranged from 2-5 (median, 3) mg.

Fewer of the gabapentin cohort received neuraxial morphine (78% vs 90%; P =.04) and more received neuraxial fentanyl (30% vs 14%; P =.01) and transverse abdominis plane block (6% vs 1%; P =.05).

Opioid consumption at 0-24 (median difference, 2; 95% CI, -15 to 30 morphine milligram equivalents [MME]; P =.38), 24-48 (median difference, 0; 95% CI, -15 to 15 MME; P =.59), and 48-72 (median difference, 5; 95% CI, -10 to 22 MME; P =.17) hours did not differ between gabapentin recipients and controls. Stratifying by neuraxial morphine did not reveal any patterns.

Gabapentin recipients reported significantly higher pain scores at 48-72 hours (P =.003). Stratified by neuraxial morphine receipt, those who received neuraxial morphine and gabapentin reported higher pain scores (P =.005) but not those who did not receive neuraxial morphine (P =.15).

In a regression analysis, the only predictor associated with opioid consumption at 0-24 hours was acetaminophen total dose at 0-24 hours (mean difference, 20.20; 95% CI, 4.18-36.23; P =.01).

These data did not support the use of gabapentin in order to decrease opioid consumption among women undergoing CD who were chronic buprenorphine users.

Reference

Ende HB, Bauchat JR, Sorabella LL, et al. Post-cesarean gabapentin is not associated with lower opioid consumption or pain scores in women on chronic buprenorphine therapy: A 10-year retrospective cohort study.J Clin Anesth. 2021;77:110600. doi:10.1016/j.jclinane.2021.110600