Key result
Perioperative gabapentinoids in children show potential benefits in reducing emergence agitation, postoperative nausea and vomiting, and chronic postsurgical pain, despite decreasing benefits seen in adult trials.
Why the study?
Gabapentinoids have been commonly administered perioperatively, but as adult data show less benefit and adverse side effects, the evidence for and against their pediatric perioperative use needed examination.
Do perioperative gabapentinoids reduce postoperative pain, opioid consumption, emergence agitation, and PONV in pediatric surgical patients?
Do perioperative gabapentinoids reduce postoperative pain, opioid consumption, emergence agitation, and PONV in pediatric surgical patients?
While adult data shows limited acute pain benefit and increased adverse effects, pediatric perioperative gabapentinoids may be useful for reducing emergence agitation, PONV, and chronic postsurgical pain.
Evidence on perioperative gabapentinoids in children remains mixed; leaves open optimal pediatric dosing and safety trials.
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.
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Li et al. (2023) conducted a review in Perioperative pain, emergence agitation, and postoperative nausea and vomiting. Gabapentinoids (gabapentin and pregabalin) vs. Placebo or standard of care was evaluated on Postoperative pain, opioid consumption, emergence agitation, and postoperative nausea and vomiting (PONV). Perioperative gabapentinoids in children show potential benefits in reducing emergence agitation, postoperative nausea and vomiting, and chronic postsurgical pain, despite decreasing benefits seen in adult trials.
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