Editorial  |   August 2020
Perioperative Gabapentinoids: Deflating the Bubble
Author Notes
  • From the Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina (E.D.K.); the Anesthesiology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (J.D.C.); the Department of Anesthesiology, Stanford University School of Medicine, Stanford, California (J.D.C.); and the Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan (S.K.).
  • This editorial accompanies the article on p. 265.
    This editorial accompanies the article on p. 265.×
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Accepted for publication April 30, 2020. Published online first on June 26, 2020.
    Accepted for publication April 30, 2020. Published online first on June 26, 2020.×
  • Address correspondence to Dr. Kharasch: evan.kharasch@duke.edu
Article Information
Editorial / Central and Peripheral Nervous Systems / Pain Medicine / Opioid
Editorial   |   August 2020
Perioperative Gabapentinoids: Deflating the Bubble
Anesthesiology 8 2020, Vol.133, 251-254. doi:https://doi.org/10.1097/ALN.0000000000003394
Anesthesiology 8 2020, Vol.133, 251-254. doi:https://doi.org/10.1097/ALN.0000000000003394
Prescription of gabapentin and pregabalin in the perioperative period has become increasingly common, if not de rigueur. These gabapentinoids have become ubiquitous components of protocols for early recovery after surgery and multimodal analgesia. Neither is approved by the U.S. Food and Drug Administration for preventing or treating surgical pain, but their use is predicated on widespread belief in their benefit, including pain reduction and opioid sparing, as well as their lack of side effects and risks. Nevertheless, these longstanding beliefs have recently been challenged.
In this issue of Anesthesiology, Verret et al.1  report a systematic review and meta-analysis of perioperative gabapentinoids for the management of postoperative acute pain. The analysis comprised 281 randomized clinical trials involving 24,682 adults, comparing gabapentinoids to placebo or another analgesic regimen or usual care, when initiated between 1 week before and 12 h after elective or emergent surgery under any type of anesthesia. The primary outcome was pain 6, 12, 24, 48, and 72 h after surgery. The results were statistically significant but clinically unimportant less postoperative pain at all primary time points (3 to 10% less), no difference in the proportion of patients achieving “appreciable” analgesia, no difference in subacute pain (postoperative weeks 4 to 12), and no effect on chronic postoperative pain (3 months or longer), for both gabapentin and pregabalin, regardless of when administered. Gabapentinoids were associated with statistically lower but clinically unimportant less postoperative opioid use (8 mg of morphine equivalent at 24 h). They were associated with less postoperative nausea and vomiting but more adverse effects, including dizziness and visual disturbances. The authors concluded that these data do not support the routine use of pregabalin or gabapentin for the management of postoperative pain in adults.