Why is gabapentin given after surgery?

In this article:

• What is gabapentin used for after surgery? 
• How does gabapentin work for pain management?
• Gabapentin side effects 
• How long should you take gabapentin after surgery?
• Gabapentin alternatives for pain management

In this article

• What is gabapentin used for after surgery? 
• How does gabapentin work for pain management?
• Gabapentin side effects 
• How long should you take gabapentin after surgery?
• Gabapentin alternatives for pain management

Since its FDA approval in 1993, gabapentin has been one of the most commonly prescribed epilepsy medications—but that’s not its only use. Doctors also prescribe it for postherpetic neuralgia, restless leg syndrome, some psychiatric conditions, and if you find yourself coming to after surgery, you may have a dose waiting for you. Gabapentin’s pain management powers have made it a popular drug for controlling postoperative pain.

For anyone with a surgery coming up, this might raise questions like: what does it do? Is it safe? Are there side effects? How long will I need to take it? We’ve got answers below.

What is gabapentin used for after surgery? 

​​Surgery can be hard on the body. Even though it’s necessary for certain conditions, it might cause pain and discomfort afterward. Sometimes, it lasts just a couple of days, but for other people, it could result in pain that lasts much longer. It depends on the type of surgery and a person’s medical history. But no matter the circumstances, surgeons always have a pain relief plan in place, and it might include gabapentin.

“Gabapentin is most effective in surgeries that might involve nerve trauma, like spinal surgery, joint replacements, or even some types of abdominal surgery,” says Dr. Taher Saifullah, founder of Spine & Pain Institute Los Angeles. “It’s also a great option for patients who have a history of chronic pain or are at higher risk for nerve pain after surgery.” In fact, a placebo-controlled trial from the Journal of Neurosurgical Anesthesiology demonstrated that gabapentin reduced pain scores and increased patient satisfaction on the day after spinal surgery.

It’s not always necessary, though. And because it may cause dependence, doctors may opt for non-steroidal anti-inflammatory drugs for some surgeries. Plus, there have been some recent studies that show conflicting evidence on the analgesic effects of gabapentin after surgery.

That said, intravenous or oral gabapentin is often part of a multimodal analgesia program, which may include other drugs like opioids. “Gabapentin is not an opioid or a narcotic, and studies have shown that it is an effective pain treatment for post-op patients,” says Dr. Robert Applebaum, MD, board-certified plastic surgeon and the CEO of Applebaum MD. “In addition, it can reduce the risk of opioid dependency by 35%. So while gabapentin is an effective pain treatment, its greatest benefit may be that it reduces further risk to the patient by lessening the chances of opioid dependency.”

This is important because opioid addiction is an epidemic in the U.S. According to the National Institute on Drug Abuse, overdose deaths involving opioid use rose from 21,089 in 2010 to 81,806 in 2022. Gabapentin has its own risks of abuse and dependence, but it’s not as widespread as opioid abuse.

Some people may experience the effects of gabapentin right away, although it can take around a week for it to achieve full effects and sometimes up to a month.

How does gabapentin work for pain management?

But if gabapentin is technically an anticonvulsant medication, how does it relieve pain? It has to do with how it works in the brain. While the exact mechanism of action is unclear, it acts on calcium channels to slow down certain neurotransmitters that may trigger pain and seizures.

“Gabapentin is particularly effective for calming down overactive nerves after surgery,” Dr. Saifullah says. “During certain procedures, nerves can be irritated or damaged, leading to sharp, burning, or shooting pain, which is different from the dull, achy pain people usually expect. Gabapentin works by altering how these pain signals are processed, making it especially helpful for this nerve-related pain, which isn’t always addressed well by traditional painkillers.”

In cases of neuropathic pain, gabapentin won’t heal or reverse nerve damage. Instead, it will just affect how those nerves interact. So, even though it can prevent seizures and nerve pain, it won’t get rid of them for good.

Gabapentin side effects 

One of the main concerns about prescribing gabapentin before or after surgery is the potential for adverse effects, especially in older people. Research suggests that the two most common side effects when gabapentin is used for postoperative analgesia are somnambulance and dizziness, which may affect recovery. Plus, it can cause rare but serious adverse events like respiratory depression, muscle damage, severe allergic reactions, and suicidal thoughts. 

Doctors often take precautions to help minimize the incidence of side effects. For example, Dr. Saifullah says, “Starting with a low dose and gradually increasing it helps minimize side effects like drowsiness, dizziness, or confusion, which can be concerning, particularly in older adults.” Doctors will also “monitor kidney function, as gabapentin is processed through the kidneys, and may need to adjust the dosage for patients with kidney issues.”

Since the use of gabapentin may lead to abuse or dependence, it’s important to understand the risks before taking it. Because it may cause dependence, gabapentin can also cause withdrawal symptoms, including nausea, dizziness, headaches, insomnia, and anxiety, according to the American Addiction Centers. That’s why doctors usually have their patients taper off the medication gradually rather than stop it abruptly.

How long should you take gabapentin after surgery?

The optimal dosage for preoperative or perioperative gabapentin depends on the patient and surgical procedure. However, a review of studies from Anesthesiology found that higher doses of gabapentin—like 600, 900, or 1,200 mg—were typically more effective in pain control and reducing opioid consumption than lower doses like 300 mg.

How long after the surgery you need to take it can also vary. One randomized controlled trial demonstrated that its benefits might drop off after the second postoperative day, but other studies found it effective 3–6 weeks after surgery. Your healthcare provider will make the call based on the type of surgery, your level of pain, other necessary medications, and your medical history.

Either way, it’s important to note gabapentin’s potential for abuse and addiction. The US Drug Enforcement Agency (DEA) hasn’t labeled it a controlled substance at the federal level, but several states have. One study of older adults found that 20% of patients prescribed postoperative gabapentin were still getting refills 90 days later, which may increase the risk for side effects or drug interactions. Additionally, a systematic review found that 15–22% of people who misused gabapentin also abused opioids. 

So, it’s important to consult your healthcare provider about any side effects of long-term use or if you think you may be addicted. But don’t simply stop taking gabapentin cold turkey because you may experience withdrawal. Your healthcare provider can come up with a safe tapering plan instead.

Gabapentin alternatives for pain management

Of course, gabapentin is just one of several options for postoperative pain management, including some that don’t have the same risks. The best alternative for you will depend on your condition, surgery, other medications, and healthcare provider’s preferences, but here are a few of the most common options.

• Non-steroidal anti-inflammatory drugs (NSAIDs): These common non-opioid pain meds can reduce pain and inflammation without causing dependence or sedation. Drugs like ibuprofen and naproxen are available over the counter and, for higher doses, via prescription. However, they might not be viable for people who have kidney problems, ulcers, or are taking blood thinners.
• Other non-opioid analgesics: The most popular of these drugs is acetaminophen (Tylenol). Unlike NSAIDs, they won’t treat inflammation, but it’s easier on the stomach. They’re often used alongside opioids.
• Opioids: Drugs like oxycodone, hydrocodone, codeine, and morphine are powerful painkillers, but they have a significant risk of abuse and addiction. They’ve long been a mainstay in pain management, and doctors may still use them for acute postoperative pain. However, they’re often more careful with these drugs now.