Where Will Gabapentin’s Bumpy Road Lead us? A Narrative Review of Pediatric Perioperative Gabapentinoids

Abstract Purpose of Review Gabapentinoids, including gabapentin and pregabalin, have been commonly administered in the perioperative period since opioid-sparing effects were found in adults in the early 2000s. This review examines the current evidence for and against the perioperative use of gabapentinoids in children and identifies potential future directions for research. Recent Findings Many factors led to increasing use of gabapentinoids for surgical patients. The national opioid epidemic hastened the move toward the use of multimodal analgesia and early recovery after surgery protocols for both adults and children. However, subsequent adult studies have found less benefit in postoperative pain reduction than once thought, while others have investigated substantial adverse side effects. The most convincing data supporting the use of pediatric perioperative gabapentinoids show reductions in emergence agitation, postoperative nausea and vomiting (PONV), and chronic persistent surgical pain. Summary As adult trials of perioperative gabapentinoids show decreasing benefits in postoperative pain, opioid consumption, and postoperative nausea and vomiting (PONV) amidst increasing concerns of adverse side effects, benefits for children focus more on reduction in emergence agitation, PONV, and chronic postsurgical pain with more research needed to explore optimal dosing regimens and potential adverse side effects.