Gabapentin (Perioperative)
Brand names: Neurontin
Gabapentin is a gabapentinoid sometimes used perioperatively as an adjunct for postoperative and neuropathic pain and to reduce opioid requirements.
The product information we hold does not support a dose for this page's specific use, route or population, so none is shown. Follow your local or national guideline, and confirm against the product SmPC.
The licensed dosing — for the medicine's licensed uses, which may differ from this page's — is on Gabapentin.
Clinical monograph
How it works
It binds the alpha-2-delta subunit of voltage-gated calcium channels, reducing excitatory neurotransmitter release and modulating nociceptive signalling.
Prescribing in practice
- Combined with opioids and other CNS depressants it potentiates sedation and respiratory depression, a particular concern in the elderly and those with respiratory compromise, so routine perioperative use is now discouraged.
- Reduce the dose in renal impairment as it is renally excreted and accumulates.
- It is a controlled drug with potential for misuse and dependence, and abrupt withdrawal after regular use can cause discontinuation symptoms.
Monitoring
Monitor sedation, respiratory status and pain scores, with extra vigilance when combined with opioids and in renal impairment.
Counselling the patient
- It can make you drowsy and dizzy, especially alongside strong painkillers.
- Do not stop it suddenly if you have been taking it regularly.
Evidence & guidelines
Evidence for perioperative gabapentinoids is mixed, and guidance now cautions against routine use because sedation and respiratory harms may outweigh opioid-sparing benefits.
Reference: MHRA Drug Safety Update 2017; Tiippana et al. (2007) meta-analysis; PROSPECT Guidelines; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).
Related
Curated clinical cross-links plus same-class fallbacks.
- ASA Physical Status Classification · Pre-operative Risk
- Phenytoin Correction for Albumin / Renal Failure · Drug Dosing
- POSSUM Score for Surgical Morbidity and Mortality · Perioperative Risk
- SORT (Surgical Outcome Risk Tool) · Perioperative Risk
- Revised Cardiac Risk Index (RCRI / Lee Index) · Perioperative Risk
- ASA Physical Status Classification · Perioperative Risk
- Major Trauma — Primary Survey (ATLS) · ATLS 10th Edition; JRCALC; NICE NG39
- Major Haemorrhage / Massive Transfusion · BCSH; RCOA; RCEM; RCS — BCSH Guidelines
- Burns — TBSA Estimation & Fluid Resuscitation · British Burn Association; EMSB; RCEM 2024
- Lower Gastrointestinal Bleed · NICE; BSG; ACPGBI — Commissioning Guide
- Acute Pancreatitis · NICE; IAP/APA; ACPGBI — CG104
- Hypertrophic Pyloric Stenosis · BAPS / RCPCH