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Gabapentinoid Use in Perioperative Care and Current Controversies

  • Acute Pain Medicine (R Urman, Section Editor)
  • Published:
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Abstract

Purpose of Review

This review summarizes the risks and benefits of gabapentinoids (gabapentin and pregabalin) for perioperative pain control and the controversies surrounding their use in a variety of settings. We review current literature with the goal of providing patient-centric and procedure-specific recommendations for the use of these medications.

Recent Findings

Gabapentinoids are among the most prescribed medications in the USA, and typically for off-label indications such as postoperative pain. In the perioperative setting, multimodal analgesic or “opioid-sparing” regimens have become the standard of care—and some clinical protocols include gabapentinoids. At the same time, guidelines regarding the perioperative use of gabapentinoids are conflicting and evidence supporting their broad use is lacking.

Summary

Gabapentinoids administered perioperatively reduce opioid requirements and pain scores for a variety of surgeries. The extent of opioid and pain reduction, however, is not always clinically significant. These medications reduce postoperative nausea and vomiting as well as pruritis, likely as a feature of reducing opioid intake, but are associated with side effects such as dizziness, ataxia, and cognitive dysfunction. Gabapentinoids also increase the risk of respiratory depression, in particular when paired with opioids. There is thus evidence suggesting that the routine use of these medications for perioperative pain management is not recommended. An individualized, patient- and surgery-specific approach should be used, although research is still needed to determine risks and benefits during perioperative use.

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Authors and Affiliations

  1. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Akash S. Patel & Richard D. Urman

  2. Department of Anesthesia & Perioperative Care, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143, USA

    Christopher R. Abrecht

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Correspondence to Richard D. Urman.

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Richard D. Urman reports unrelated funding and/or fees from Merck, Medtronic, AcelRx, Pfizer, and Heron. Akash S. Patel and Christopher R. Abrecht have nothing to disclose.

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Patel, A.S., Abrecht, C.R. & Urman, R.D. Gabapentinoid Use in Perioperative Care and Current Controversies. Curr Pain Headache Rep 26, 139–144 (2022). https://doi.org/10.1007/s11916-022-01012-2

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