Gabapentin as an Adjunct to Paracervical Block for Perioperative Pain Management

Phase 4

Completed

Conditions: Pain

Interventions: Drug: Placebo
Drug: Gabapentin

Registration Number: NCT02944656

Lead Sponsor: Emory University

Brief Summary: This is a randomized controlled trial of gabapentin 600 mg compared to placebo given 1-2 hours preoperatively in conjunction with perioperative paracervical block for surgical abortion. The researchers hypothesize that adding gabapentin to local anesthesia will reduce perioperative and postoperative pain associated with surgical abortion. Additionally, the researchers hypothesize that gabapentin will reduce nausea, vomiting, anxiety, and consumption of pain medication.

Detailed Description: Project Summary

Justification for the project

One half of all pregnancies among American women are unintended, with nearly 4 in 10 ending in pregnancy termination by abortion. Elective abortions are among the most common outpatient surgical procedure, with an estimated 46 million performed worldwide annually. The management of pain is critical to patient care throughout the abortion experience since the vast majority of women will experience pain with the procedure. Patients are most affected by pain during paracervical block, cervical dilation, suction aspiration, and post operatively with uterine cramping. Innovation in pain control and reduction of anxiety, nausea and vomiting using a low cost, well-tolerated intervention could impact thousands of women each year.

Proposed research

This is a randomized controlled trial of gabapentin 600 mg compared to placebo given 1-2 hours preoperatively in conjunction with perioperative paracervical block for surgical abortion. The researchers hypothesize that adding gabapentin to local anesthesia will reduce perioperative and postoperative pain associated with surgical abortion. Additionally, the researchers hypothesize that gabapentin will reduce nausea, vomiting, anxiety, and consumption of pain medication.

New features

Gabapentin as an adjunct o pain management has proven beneficial in gynecological surgery. Its use in similar surgical settings as an adjunct to pain management regiments has proven to be beneficial. It is generally well tolerated, inexpensive, has minimal side effects, and few contraindications.

Problems anticipated

The high volume at the study clinic will benefit recruitment efforts, however, as the coordination of this study may potentially disrupt clinic flow there will be limits on daily recruitment. Postoperative follow-up may be challenging, thus to reduce the impact of loss to follow-up, most of the outcomes are measured on the same day as the procedure. Further, multiple contact approaches will be employed and a second incentive offered after completion of the postoperative assessment.

Recruitment & Eligibility

Status: COMPLETED

Sex: Female

Target Recruitment: 114

Inclusion Criteria

Women >=18 years-old
Presenting for a surgical abortion
Fluency in English and able to provide informed consent
Has a driver to take them home following the procedure

Exclusion Criteria

Allergy, sensitivity or contraindication to gabapentin
Severe renal disease
Currently using gabapentin or pregabalin
Contraindication to outpatient abortion under local anesthesia

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Placebo group	Placebo	This group will receive local anesthesia per clinic protocol plus placebo 1-2 hours preoperatively.
Gabapentin group	Gabapentin	This group will receive local anesthesia per clinic protocol plus Gabapentin 600mg 1-2 hours preoperatively.

Primary Outcome Measures

Name	Time	Method
Pain at Time of Uterine Evacuation	During the procedure on Study Day 1	The primary outcome measure is a pain score using a 100-mm visual analog scale (VAS) measured intraoperatively at time of evacuation. "No pain" is scored as 0 and "worst pain imaginable" is scored as 100.

Secondary Outcome Measures

Name	Time	Method
Perioperative Pain Level	Pre-procedure through post-procedure on Study Day 1	Pain level at a variety of time points will be measured using a 100-mm visual analog scale (VAS) to log the change in pain levels between the study arms. "No pain" is scored as 0 and "worst pain imaginable" is scored as 100. Pain will be assessed immediately prior to the procedure, at completion of the procedure (removal of the speculum), 10 minutes following the procedure, and 30 minutes following the procedure (at discharge).
Moderate Pain at Postoperation Follow-up Assessment	Postoperative Day 1	During the Postoperative Day 1 phone call, participants self reported how much they experienced moderate pain in the last 24 hours where 10 = none of the time and 0 = all of the time. "Moderate pain" was defined according to the perception of each participant.
Anxiety Levels	Pre-procedure through post-procedure on Study Day 1	Participants reported how much anxiety they were currently experiencing on a 100-point scale where "No Anxiety" is scored as 0 and "Extremely Anxious" is scored as 100. Anxiety is reported for the time periods of immediately prior to the procedure, 10 minutes after the procedure, and 30 minutes after the procedure.
Side Effects	10 and 30 minutes post procedure on Study Day 1	Participants were asked if they experienced dizziness, lack of muscle control, sleepiness or drowsiness, weakness or lack of energy, headache, or visual changes.
Vomiting Since Leaving Clinic	Postoperative Day 1	During the Postoperative Day 1 phone call, participants self reported whether or not they had vomited since leaving the clinic.
Number of Participants Using Pain Medication	Postoperative Day 1	The number of participants reporting filling and using the prescription for ibuprofen postoperatively. During the follow-up phone call on the day after the procedure, participants were asked whether or not they filled the pain medication prescription and if they took any of the medication.
Perioperative Nausea	Pre-procedure through post-procedure on Study Day 1	Nausea level was measured using a 100-mm visual analog scale (VAS) to log the change in nausea levels between the study arms. No nausea is reported as 0 while "worst nausea I have ever felt" is reported at 100. Nausea was reported immediately prior to the procedure, 10 minutes following the procedure, and 30 minutes following the procedure.
Perioperative Vomiting	Pre-procedure through post-procedure on Study Day 1	Participants reported if they vomited during the perioperative period to assess changes in vomiting incidences between the study arms. Vomiting is reported for the time periods of immediately prior to the procedure, 10 minutes following the procedure, and 30 minutes following the procedure.
Severe Pain at Postoperation Follow-up Assessment	Postoperative Day 1	During the Postoperative Day 1 phone call, participants self reported how much they experienced severe pain in the last 24 hours where 10 = none of the time and 0 = all of the time. "Severe pain" was defined according to the perception of each participant.
Nausea or Vomiting at Postoperation Follow-up Assessment	Postoperative Day 1	During the Postoperative Day 1 phone call, participants self reported how much they experienced nausea or vomiting in the last 24 hours where 10 = none of the time and 0 = all of the time. Nausea and vomiting were self-reported together as a single outcome.
Overall Satisfaction With the Procedure	Postoperative Day 1	Overall satisfaction with the procedure was assessed on a 10-point scale on the day after the procedure, where 1 = very dissatisfied and 10 = very satisfied.