Key result
Perioperative gabapentinoids appear to reduce pain, nausea, and emergence delirium in certain pediatric surgical populations without a significantly increased risk of adverse effects.
Why the study?
Effective pediatric perioperative pain management requires multimodal analgesia, and while gabapentinoids show modest benefits in adults with unwanted side effects, their utility and safety profile in children require clarification.
Does the perioperative use of gabapentinoids improve pain control and reduce emergence delirium in pediatric surgical patients?
Does the perioperative use of gabapentinoids improve pain control and reduce emergence delirium in pediatric surgical patients?
Perioperative gabapentinoids may be a beneficial adjunct for managing pain and reducing emergence delirium in specific pediatric surgical populations, though further research is needed to define optimal dosing regimens.
Answers are grounded in this paper and cite their sources.
May support adjunctive use in select pediatric cases; leaves open optimal dosing and broader validation by RCTs.
Effective management of pediatric perioperative pain is typically goal-directed and multimodal, requiring various imperfect agents in combination to provide analgesia and support recovery. Gabapentinoids are one such class of agents often used in pediatric analgesic and enhanced recovery pathways. In adults, gabapentinoids have been associated with a modest reduction in pain scores but are often avoided due to undesired side effects. Children may be less susceptible to these unwanted effects, and the reduction in pain, agitation, and post-operative nausea and vomiting seen with these medications may confer significant benefit. While further studies are needed, to date there is no evidence to suggest a significantly increased risk of adverse effects in generally healthy children treated with gabapentinoids in the perioperative period. Although current evidence does not support their indiscriminate use, there appears to be a subset of pediatric surgical patients who stand to benefit from perioperative gabapentinoids. Pediatric use should not be abandoned, but rather further investigated to support thoughtful goal-directed application.
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Burjek et al. (2023) conducted a review in Perioperative pain. Gabapentinoids (gabapentin and pregabalin) vs. Placebo or standard care was evaluated. Perioperative gabapentinoids appear to reduce pain, nausea, and emergence delirium in certain pediatric surgical populations without a significantly increased risk of adverse effects.
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