Preoperative Gabapentin for Vaginal Prolapse Procedures: A Randomized Trial

Importance Perioperative gabapentin is widely used in gynecology ERAS protocols, but evidence for its use for vaginal prolapse procedures is very limited. Objective The objective of this study was to evaluate the effect of preoperative gabapentin on postoperative opioid use in patients undergoing vaginal apical suspension procedures for pelvic organ prolapse. Study Design This was a double-blind, randomized, placebo-controlled clinical trial conducted at a tertiary care center. Participants received either 300 mg of gabapentin or placebo 1 hour before surgery, along with 975 mg of acetaminophen and 400 mg of celecoxib. The primary outcome was total opioid consumption in the first 24 hours postoperatively in morphine milligram equivalents. Secondary outcomes included pain scores, time to discharge, adverse events, and adequacy of pain control. Statistical analysis included the Wilcoxon rank sum and Fisher exact tests. A sample size of 46 per group was planned to achieve 80% power. Results From January 2023 through October 2024, 110 participants were enrolled, and 100 were randomized and received the intervention (50 per group). Demographics and patient characteristics were similar between groups except for preoperative/intraoperative opioids. There were no significant differences between the placebo and gabapentin groups in postoperative 24-hour opioid use ( P =0.15) or any secondary outcomes. After correcting for the difference in preoperative/intraoperative opioid use with regression models, there were still no significant differences in the primary or secondary outcomes. The same results held true for a per-protocol analysis, which excluded 5 participants. Conclusions A single 300-mg preoperative dose of gabapentin did not significantly reduce opioid use or improve pain control in patients undergoing vaginal apical suspension. These findings suggest limited utility for the routine use of gabapentin in this clinical context.