Gabapentinoid Use in Perioperative Care and Current Controversies

AbstractPurpose of ReviewThis 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 FindingsGabapentinoids 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.SummaryGabapentinoids 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 theroutine use of these medications for perioperative pain management is not recommended. An ...

Source: Current Pain and Headache Reports - January 27, 2022 Category: Neurology Source Type: research