Routine Perioperative Gabapentin Administration

Summary by Zachary Headman DO, 01.04.22

https://pubmed.ncbi.nlm.nih.gov/32667153/

The article challenges the concept of routine use of perioperative gabapentinoids 

- "Over the past two decades, evidence of benefit from routine perioperative administration of gabapentinoids has diminished, while evidence of harm has increased." 

- Associated side effects: sedation, somnolence, cognitive impairment that can delay recovery, pulmonary complications (respiratory failure, pneumonia, reintubation, pulmonary edema, noninvasive ventilation, or invasive mechanical ventilation), intensive care unit admission, more naloxone use, and no decreased opioid requirements or length of stay. 

- "The French Society of Anesthesia and Intensive Care Medicine now state that gabapentinoids should not be used systematically or in outpatient surgery. Other societies should follow. As the weight of evidence has shifted and the risk–benefit balance tilted away from benefit, evidence-based practice impels revising if not eliminating the routine use of perioperative gabapentinoids in adults."

Again, this is purely challenging routine use of gabapentin (for all). Adding it as an adjunct when clinically appropriate is reasonable, and just like everything we do, it is crucial to individualize clinical decisions on a case by case basis.