Skip to main content
NCBI home page
Medline Book to support NIHPA logoLink to Medline Book to support NIHPA
. 2026 Feb;30(9):1–144. doi: 10.3310/PLMH9787

Gabapentin as an adjunct to multimodal pain regimens in surgical patients: the GAP placebo-controlled RCT and economic evaluation.

Sarah Baos, Terrie Walker-Smith, Mandy Lui, Elizabeth A Stokes, Jingjing Jiang, Maria Pufulete, Ben Gibbison, Chris A Rogers; GAP Investigators
PMCID: PMC12907993  PMID: 41660750

Abstract

BACKGROUND

Gabapentin is an anticonvulsant medication with a United Kingdom licence to treat partial seizures and neuropathic pain. It is used off-licence for acute pain and is frequently added to multimodal analgesic regimens after surgery to try and reduce opioid use while controlling pain effectively.

OBJECTIVE

To test the hypothesis that gabapentin reduces opioid use after major surgery and speeds up recovery, thereby reducing postoperative hospital length of stay compared to standard multimodal analgesia.

DESIGN, SETTING AND PARTICIPANTS

The GAP study was a multicentre, blinded, randomised controlled trial in patients aged ≥ 18 years, undergoing cardiac, thoracic or abdominal surgery with an expected postoperative stay of ≥ 2 days in seven National Health Service hospitals. The trial was designed to provide 90% power to detect a difference of 12.5% in the proportion of participants discharged by the median length of stay in each specialty (500 participants/specialty), which was reduced to 80% (340 participants/specialty) due to COVID-19-related recruitment challenges.

INTERVENTIONS

Participants were randomised 1 : 1 (stratified by surgical specialty) to receive either gabapentin (600 mg before surgery, 300 mg twice daily for 2 days after surgery) or placebo as an adjunct to multimodal pain regimens.

MAIN OUTCOME MEASURES

Primary outcome was length of stay. Secondary outcomes included acute and chronic (Brief Pain Inventory) pain, total opioid use, adverse health events, health-related quality of life (-EQ-5D-5L, Short Form questionnaire-12 items physical component score and mental component score), resource use; cost-effectiveness (outcome measure quality-adjusted life-years using EQ-5D, five-level version).

RESULTS

One thousand one hundred and ninety-six (cardiac 500, thoracic 346, abdominal 350) participants consented and were randomised. Baseline characteristics were well balanced across the two groups: median age: 68 years; male sex 796/1195 (66.4%). Of the participants, 223/1195 (18.7%) did not receive all prescribed medication or received medication out of window. There was no difference in length of stay; median placebo (n = 589): 6.15, gabapentin (n = 595): 5.94 days [hazard ratio for discharge 1.07, 95% confidence interval (0.95 to 1.20), p = 0.26]. Opioid use in-hospital differed between surgical specialties (p = 0.001); in the abdominal specialty, it was significantly lower in the gabapentin group in 4 of the first 5 postoperative days [range -26% (-46% to 0%) to -36% (-52% to -14%)], with no differences in the cardiac specialty nor in the thoracic specialty beyond day 2. During follow-up, opioid use was similar in the two groups across all specialties. Acute pain beyond 24 hours was similar (p ≥ 0.15). The incidence of one or more serious adverse events was placebo: 189/595 (31.7%); gabapentin: 195/599 (32.6%). Health-related quality of life was similar [EQ-5D: mean difference -0.014 (-0.036 to 0.009), Short Form questionnaire-12 items physical component score: -0.87 (-1.71 to -0.04), Short Form questionnaire-12 items mental component score: at 4 weeks 0.74 (-1.71 to 0.42) and 4 months -0.55 (-1.61 to 0.51)]. Differences in costs and quality-adjusted life-years favoured placebo, and gabapentin was not considered cost-effective.

LIMITATIONS

GAP study tests the application of gabapentin to major body cavity surgery, but not major non-body cavity surgery, or non-major surgery. The fixed dose and limited duration of gabapentin may reduce applicability to certain populations. Reducing the power to 80% reduced the ability of the trial to detect a beneficial effect of gabapentin.

CONCLUSIONS

Among patients undergoing major cardiac, thoracic and abdominal surgery, adding gabapentin to multimodal analgesic regimes did not result in a change in length of stay, opiate use in two specialties, acute pain, or health-related quality of life, nor was it cost-effective.

FUTURE WORK

Trials to assess the place of gabapentin in major non-body cavity surgery (e.g. joint replacement), or non-major (e.g. day-care) surgery should be considered.

TRIAL REGISTRATION

This trial is registered as Current Controlled Trials ISRCTN63614165.

FUNDING

This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 15/101/16) and is published in full in Health Technology Assessment; Vol. 30, No. 9. See the NIHR Funding and Awards website for further award information.

Plain language summary

Gabapentin is a medicine used to treat epilepsy and pain caused by damaged nerves. Doctors have recently been using gabapentin to treat pain after an operation, with the intention of reducing the amount of morphine-type drugs (called ‘opioids’) needed while maintaining good pain relief. Doctors want to try to reduce the amount of opioid drugs because they cause side effects (such as dizziness and reduced breathing rate), often delaying discharge from hospital and leading to slower recovery. There is uncertainty about whether adding gabapentin to the usual painkilling drugs will result in good pain relief, with fewer side effects, and therefore faster recovery after surgery. One thousand one hundred and ninety-five adults having major heart, lung or abdominal surgery who were expected to stay in hospital for at least 2 days after their surgery. The participants were given either gabapentin or placebo (the same tablet but with no active drug) just before and twice daily for 2 days after their surgery. We measured how long they stayed in hospital after the surgery, the amount of opioid drugs they used, the amount of pain they had, what their quality of life was and how much they cost the National Health Service. We measured these during their hospital stay and at 4 weeks and 4 months after the surgery. The trial found that there was no difference in the length of hospital stay, the number of adverse health events, or National Health Service costs between people who took gabapentin and those who took the placebo. People who took gabapentin for abdominal and thoracic surgery used fewer opioid-type drugs in-hospital after their surgery – but this did not translate into better pain control or fewer side effects. Therefore, this trial tells us that doctors should stop routinely giving gabapentin to people to reduce their pain after major surgery.

Full text of this article can be found in Bookshelf.

References

  1. Baos S, Rogers CA, Abbadi R, Alzetani A, Casali G, Chauhan N, et al. Effectiveness, cost-effectiveness and safety of gabapentin versus placebo as an adjunct to multimodal pain regimens in surgical patients: protocol of a placebo controlled randomised controlled trial with blinding (GAP study). BMJ Open 2020;10:e041176. https://doi.org/10.1136/bmjopen-2020-041176 doi: 10.1136/bmjopen-2020-041176. [DOI] [PMC free article] [PubMed]
  2. Abbott TEF, Fowler AJ, Dobbs TD, Harrison EM, Gillies MA, Pearse RM. Frequency of surgical treatment and related hospital procedures in the UK: a national ecological study using hospital episode statistics. Br J Anaesth 2017;119:249–57. https://doi.org/10.1093/bja/aex137 doi: 10.1093/bja/aex137. [DOI] [PubMed]
  3. Gan TJ, Habib AS, Miller TE, White W, Apfelbaum JL. Incidence, patient satisfaction, and perceptions of post-surgical pain: results from a US national survey. Curr Med Res Opin 2014;30:149–60. https://doi.org/10.1185/03007995.2013.860019 doi: 10.1185/03007995.2013.860019. [DOI] [PubMed]
  4. Chapman CR, Vierck CJ. The transition of acute postoperative pain to chronic pain: an integrative overview of research on mechanisms. J Pain 2017;18:359.e1–38. https://doi.org/10.1016/j.jpain.2016.11.004 doi: 10.1016/j.jpain.2016.11.004. [DOI] [PubMed]
  5. VanDenKerkhof EG, Hopman WM, Reitsma ML, Goldstein DH, Wilson RA, Belliveau P, Gilron I. Chronic pain, healthcare utilization, and quality of life following gastrointestinal surgery. Can J Anaesth 2012;59:670–80. https://doi.org/10.1007/s12630-012-9712-x doi: 10.1007/s12630-012-9712-x. [DOI] [PubMed]
  6. Kinney MAO, Hooten WM, Cassivi SD, Allen MS, Passe MA, Hanson AC, et al. Chronic postthoracotomy pain and health-related quality of life. Ann Thorac Surg 2012;93:1242–7. https://doi.org/10.1016/j.athoracsur.2012.01.031 doi: 10.1016/j.athoracsur.2012.01.031. [DOI] [PMC free article] [PubMed]
  7. Oliver CM, Warnakulasuriya S, McGuckin D, Singleton G, Martin P, Santos C, et al.; PQIP project delivery team. Delivery of drinking, eating and mobilising (DrEaMing) and its association with length of hospital stay after major noncardiac surgery: observational cohort study. Br J Anaesth 2022;129:114–26. https://doi.org/10.1016/j.bja.2022.03.021 doi: 10.1016/j.bja.2022.03.021. [DOI] [PMC free article] [PubMed]
  8. National Institute for Health and Care Excellence. NG 180: Peri-operative Care. London: NICE; 2020.
  9. Shafi S, Collinsworth AW, Copeland LA, Ogola GO, Qiu T, Kouznetsova M, et al. Association of opioid-related adverse drug events with clinical and cost outcomes among surgical patients in a large integrated health care delivery system. JAMA Surg 2018;153:757–63. https://doi.org/10.1001/jamasurg.2018.1039 doi: 10.1001/jamasurg.2018.1039. [DOI] [PMC free article] [PubMed]
  10. Clarke H, Soneji N, Ko DT, Yun L, Wijeysundera DN. Rates and risk factors for prolonged opioid use after major surgery: population based cohort study. BMJ 2014;348:g1251. https://doi.org/10.1136/bmj.g1251 doi: 10.1136/bmj.g1251. [DOI] [PMC free article] [PubMed]
  11. Joint Formulary Committee. British National Formulary. National Institute for Health and Care Excellence; 2022. URL: https://bnf.nice.org.uk (accessed 19 August 2025).
  12. Dooley DJ, Taylor CP, Donevan S, Feltner D. Calcium ligands: novel modulators of neurotransmission. Trends Pharmacol Sci 2007;28:75–82. https://doi.org/10.1016/j.tips.2006.12.006 doi: 10.1016/j.tips.2006.12.006. [DOI] [PubMed]
  13. Field MJ, Oles RJ, Lewis AS, McCleary S, Hughes J, Singh L. Gabapentin (neurontin) and S-(+)-3-isobutylgaba represent a novel class of selective antihyperalgesic agents. Br J Pharmacol 1997;121:1513–22. https://doi.org/10.1038/sj.bjp.0701320 doi: 10.1038/sj.bjp.0701320. [DOI] [PMC free article] [PubMed]
  14. Taylor CP, Gee NS, Su TZ, Kocsis JD, Welty DF, Brown JP, et al. A summary of mechanistic hypotheses of gabapentin pharmacology. Epilepsy Res 1998;29:233–49. https://doi.org/10.1016/S0920-1211(97)00084-3 doi: 10.1016/s0920-1211(97)00084-3. [DOI] [PubMed]
  15. Chauhan N, Pufulete M, Rogers CA. Gabapentinoids for Acute Operative Pain_Final Survey; 2017.
  16. Alayed N, Alghanaim N, Tan X, Tulandi T. Preemptive use of gabapentin in abdominal hysterectomy: a systematic review and meta-analysis. Obstet Gynecol 2014;123:1221–9. doi: 10.1097/AOG.0000000000000289. [DOI] [PubMed]
  17. Felder L, Saccone G, Scuotto S, Monks DT, Carvalho JCA, Zullo F, Berghella V. Perioperative gabapentin and post cesarean pain control: a systematic review and meta-analysis of randomized controlled trials. Eur J Obstet Gynecol Reprod Biol 2019;233:98–106. https://doi.org/10.1016/j.ejogrb.2018.11.026 doi: 10.1016/j.ejogrb.2018.11.026. [DOI] [PubMed]
  18. Han C, Li XD, Jiang HQ, Ma JX, Ma XL. The use of gabapentin in the management of postoperative pain after total knee arthroplasty: a PRISMA-compliant meta-analysis of randomized controlled trials. Medicine (Baltimore) 2016;95:e3883. doi: 10.1097/MD.0000000000003883. [DOI] [PMC free article] [PubMed]
  19. Hwang SH, Park IJ, Cho YJ, Jeong YM, Kang JM. The efficacy of gabapentin/pregabalin in improving pain after tonsillectomy: a meta-analysis. Laryngoscope 2016;126:357–66. https://doi.org/10.1002/lary.25636 doi: 10.1002/lary.25636. [DOI] [PubMed]
  20. Maitra S, Baidya DK, Bhattacharjee S, Som A. Perioperative gabapentin and pregabalin in cardiac surgery: a systematic review and meta-analysis. Braz J Anesthesiol 2017;67:294–304. https://doi.org/10.1016/j.bjane.2016.07.014 doi: 10.1016/j.bjan.2016.07.005. [DOI] [PubMed]
  21. Sanders JG, Dawes PJD. Gabapentin for perioperative analgesia in otorhinolaryngology–head and neck surgery. Otolaryngol Head Neck Surg 2016;155:893–903. https://doi.org/10.1177/0194599816659042 doi: 10.1177/0194599816659042. [DOI] [PubMed]
  22. Straube S, Derry S, Moore RA, Wiffen PJ, McQuay HJ. Single dose oral gabapentin for established acute postoperative pain in adults. Cochrane Database Syst Rev 2010;2010:CD008183. https://doi.org/10.1002/14651858.CD008183.pub2 doi: 10.1002/14651858.CD008183.pub2. [DOI] [PMC free article] [PubMed]
  23. Toma O, Persoons B, Pogatzki-Zahn E, Van de Velde M, Joshi GP; PROSPECT Working Group collaborators. PROSPECT guideline for rotator cuff repair surgery: systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia 2019;74:1320–31. https://doi.org/10.1111/anae.14796 doi: 10.1111/anae.14796. [DOI] [PMC free article] [PubMed]
  24. Verret M, Lauzier F, Zarychanski R, Perron C, Savard X, Pinard AM, et al.; Canadian Perioperative Anesthesia Clinical Trials (PACT) Group. Perioperative use of gabapentinoids for the management of postoperative acute pain: a systematic review and meta-analysis. Anesthesiology 2020;133:265–79. https://doi.org/10.1097/ALN.0000000000003428 doi: 10.1097/ALN.0000000000003428. [DOI] [PubMed]
  25. Yu L, Ran B, Li M, Shi Z. Gabapentin and pregabalin in the management of postoperative pain after lumbar spinal surgery: a systematic review and meta-analysis. Spine 2013;38:1947–52. doi: 10.1097/BRS.0b013e3182a69b90. [DOI] [PubMed]
  26. Zhai L, Song Z, Liu K. The effect of gabapentin on acute postoperative pain in patients undergoing total knee arthroplasty: a meta-analysis. Medicine (Baltimore) 2016;95:e3673. doi: 10.1097/MD.0000000000003673. [DOI] [PMC free article] [PubMed]
  27. Wong DJN, Oliver CM, Moonesinghe SR. Predicting postoperative morbidity in adult elective surgical patients using the Surgical Outcome Risk Tool (SORT). Br J Anaesth 2017;119:95–105. https://doi.org/10.1093/bja/aex117 doi: 10.1093/bja/aex117. [DOI] [PubMed]
  28. Regenbogen SE, Cain-Nielsen AH, Norton EC, Chen LM, Birkmeyer JD, Skinner JS. Costs and consequences of early hospital discharge after major inpatient surgery in older adults. JAMA Surg 2017;152:e170123. https://doi.org/10.1001/jamasurg.2017.0123 doi: 10.1001/jamasurg.2017.0123. [DOI] [PMC free article] [PubMed]
  29. Nicholson A, Lowe MC, Parker J, Lewis SR, Alderson P, Smith AF. Systematic review and meta-analysis of enhanced recovery programmes in surgical patients. Br J Surg 2014;101:172–88. https://doi.org/10.1002/bjs.9394 doi: 10.1002/bjs.9394. [DOI] [PubMed]
  30. Luo N, Johnson J, Coons SJ. Using instrument-defined health state transitions to estimate minimally important differences for four preference-based health-related quality of life instruments. Med Care 2010;48:365–71. https://doi.org/10.1097/mlr.0b013e3181c162a2 doi: 10.1097/mlr.0b013e3181c162a2. [DOI] [PubMed]
  31. Clement ND, Weir D, Holland J, Gerrand C, Deehan DJ. Meaningful changes in the Short Form 12 physical and mental summary scores after total knee arthroplasty. Knee 2019;26:861–8. https://doi.org/10.1016/j.knee.2019.04.018 doi: 10.1016/j.knee.2019.04.018. [DOI] [PubMed]
  32. Mease PJ, Spaeth M, Clauw DJ, Arnold LM, Bradley LA, Russell IJ, et al. Estimation of minimum clinically important difference for pain in fibromyalgia. Arthritis Care Res (Hoboken) 2011;63:821–6. https://doi.org/10.1002/acr.20449 doi: 10.1002/acr.20449. [DOI] [PubMed]
  33. Bang H, Ni L, Davis CE. Assessment of blinding in clinical trials. Control Clin Trials 2004;25:143–56. https://doi.org/10.1016/j.cct.2003.10.016 doi: 10.1016/j.cct.2003.10.016. [DOI] [PubMed]
  34. Moher D, Hopewell S, Schulz KF, Montori V, Gøtzsche PC, Devereaux PJ, et al. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. BMJ 2010;340:c869. https://doi.org/10.1136/bmj.c869 doi: 10.1136/bmj.c869. [DOI] [PMC free article] [PubMed]
  35. EuroQol Group. EuroQol – a new facility for the measurement of health-related quality of life. Health Policy 1990;16:199–208. doi: 10.1016/0168-8510(90)90421-9. [DOI] [PubMed]
  36. Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res 2011;20:1727–36. https://doi.org/10.1007/s11136-011-9903-x doi: 10.1007/s11136-011-9903-x. [DOI] [PMC free article] [PubMed]
  37. NICE. NICE Health Technology Evaluations: The Manual. London: NICE; 2022. URL: www.nice.org.uk/process/pmg36/chapter/economic-evaluation-2 (accessed 23 September 2025).
  38. Public Health Scotland. Costs Book 2019–20 – R140 Number of Theatres, Expenditure and Usage. URL: https://beta.isdscotland.org/topics/finance/file-listings-fy-2019-to-2020/ (accessed 11 March 2023).
  39. Department of Health and Social Care. Drugs and Pharmaceutical Electronic Market Information Tool (eMIT). Department of Health and Social Care. URL: www.gov.uk/government/publications/drugs-and-pharmaceutical-electronic-market-information-emit (accessed 10 December 2022).
  40. NHS Business Services Authority. Prescription Cost Analysis – England – 2021/22. URL: www.nhsbsa.nhs.uk/statistical-collections/prescription-cost-analysis-england/prescription-cost-analysis-england-202122 (accessed 13 April 2023).
  41. NHS England. National Schedule of NHS Costs 2021–22. URL: www.england.nhs.uk/national-cost-collection/ (accessed 11 July 2023).
  42. Jones K, Weatherly H, Birch S, Castelli A, Chalkley M, Dargan A, et al. Unit Costs of Health and Social Care 2022 Manual. Kent, UK: Personal Social Services Research Unit (University of Kent) & Centre for Health Economics (University of York). URL: www.pssru.ac.uk/unitcostsreport/ (accessed 11 July 2023).
  43. NHS Improvement. National Schedule of Reference Costs 2017–18. URL: https://webarchive.nationalarchives.gov.uk/ukgwa/20200501111106/https://improvement.nhs.uk/resources/reference-costs/ (accessed 3 April 2020).
  44. Pope C, Turnbull J, Jones J, Prichard J, Rowsell A, Halford S. Has the NHS 111 urgent care telephone service been a success? Case study and secondary data analysis in England. BMJ Open. 2017;7:e014815. https://doi.org/10.1136/bmjopen-2016-014815 doi: 10.1136/bmjopen-2016-014815. [DOI] [PMC free article] [PubMed]
  45. Dolan P. Modeling valuations for EuroQol health states. Med Care 1997;35:1095–108. https://doi.org/10.1097/00005650-199711000-00002 doi: 10.1097/00005650-199711000-00002. [DOI] [PubMed]
  46. Hernández-Alava M, Pudney S. Econometric modelling of multiple self-reports of health states: the switch from EQ-5D-3L to EQ-5D-5L in evaluating drug therapies for rheumatoid arthritis. J Health Econ 2017;55:139–52. https://doi.org/10.1016/j.jhealeco.2017.06.013 doi: 10.1016/j.jhealeco.2017.06.013. [DOI] [PMC free article] [PubMed]
  47. Faria R, Gomes M, Epstein D, White IR. A guide to handling missing data in cost-effectiveness analysis conducted within randomised controlled trials. PharmacoEconomics 2014;32:1157–70. https://doi.org/10.1007/s40273-014-0193-3 doi: 10.1007/s40273-014-0193-3. [DOI] [PMC free article] [PubMed]
  48. Briggs A, Clark T, Wolstenholme J, Clarke P. Missing.... presumed at random: cost-analysis of incomplete data. Health Econ 2003;12:377–92. https://doi.org/10.1002/hec.766 doi: 10.1002/hec.766. [DOI] [PubMed]
  49. White IR, Royston P, Wood AM. Multiple imputation using chained equations: issues and guidance for practice. Stat Med 2011;30:377–99. https://doi.org/10.1002/sim.4067 doi: 10.1002/sim.4067. [DOI] [PubMed]
  50. Rubin DB. Multiple Imputation for Non-response in Surveys. New York, NY: John Wiley; 1987.
  51. Manca A, Hawkins N, Sculpher MJ. Estimating mean QALYs in trial-based cost-effectiveness analysis: the importance of controlling for baseline utility. Health Econ 2005;14:487–96. https://doi.org/10.1002/hec.944 doi: 10.1002/hec.944. [DOI] [PubMed]
  52. O’Brien B, Burrage PS, Ngai JY, Prutkin JM, Huang CC, Xu X, et al. Society of Cardiovascular Anesthesiologists/European Association of Cardiothoracic Anaesthetists Practice Advisory for the Management of Perioperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth 2019;33:12–26. https://doi.org/10.1053/j.jvca.2018.09.039 doi: 10.1053/j.jvca.2018.09.039. [DOI] [PubMed]
  53. NHS England. National Adult Cardiac Surgery Audit. 2023. URL: https://scts.org/news/570/the_nacsa_2023_summary_report (accessed 20 August 2025).
  54. Martinez V, Carles M, Marret E, Beloeil H; Regional Anaesthesia and Pain Committee of the French Society of Anaesthesiology and Intensive Care Medicine. Perioperative use of gabapentinoids in France. Mismatch between clinical practice and scientific evidence. Anaesth Crit Care Pain Med 2018;37:43–7. doi: 10.1016/j.accpm.2017.01.010. [DOI] [PubMed]
  55. Johansen ME. Gabapentinoid use in the United States 2002 through 2015. JAMA Intern Med 2018;178:292–4. doi: 10.1001/jamainternmed.2017.7856. [DOI] [PMC free article] [PubMed]
  56. Bongiovanni T, Gan S, Finlayson E, Ross JS, Harrison JD, Boscardin WJ, Steinman MA. Trends in the use of gabapentinoids and opioids in the postoperative period among older adults. JAMA Netw Open 2023;6:e2318626. https://doi.org/10.1001/jamanetworkopen.2023.18626 doi: 10.1001/jamanetworkopen.2023.18626. [DOI] [PMC free article] [PubMed]
  57. Throckmorton DC, Gottlieb S, Woodcock J. The FDA and the next wave of drug abuse – proactive pharmacovigilance. N Engl J Med 2018;379:205–7. doi: 10.1056/NEJMp1806486. [DOI] [PubMed]
  58. Evoy KE, Morrison MD, Saklad SR. Abuse and misuse of pregabalin and gabapentin. Drugs 2017;77:403–26. doi: 10.1007/s40265-017-0700-x. [DOI] [PubMed]
  59. NHS England. Advice for Prescribers on the Risk of the Misuse of Pregabalin and Gabapentin. 2014. URL: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/385791/PHE-NHS_England_pregabalin_and_gabapentin_advice_Dec_2014.pdf (accessed 20 August 2025).
  60. Spence D. Bad medicine: gabapentin and pregabalin. BMJ 2013;347:f7615. doi: 10.1136/bmj.f6747. [DOI] [PubMed]
  61. Smith RV, Havens JR, Walsh SL. Gabapentin misuse, abuse and diversion: a systematic review. Addiction 2016;111:1160–74. doi: 10.1111/add.13324. [DOI] [PMC free article] [PubMed]
  62. Molero Y, Larsson H, D’Onofrio BM, Sharp DJ, Fazel S. Associations between gabapentinoids and suicidal behaviour, unintentional overdoses, injuries, road traffic incidents, and violent crime: population based cohort study in Sweden. BMJ 2019;365:l2147. doi: 10.1136/bmj.l2147. [DOI] [PMC free article] [PubMed]
  63. Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, et al. Management of Postoperative Pain: A Clinical Practice Guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain 2016;17:131–57. https://doi.org/10.1016/j.jpain.2015.12.008 doi: 10.1016/j.jpain.2015.12.008. [DOI] [PubMed]
  64. Prospect: Procedure-specific Postoperative Pain Management. Better Postoperative Pain Management. URL: https://esraeurope.org/prospect/ (accessed 26 July 2023).
  65. Wu JM, Dieter AA, Feliciano KM, Geller EJ, Willis-Gray M. Randomized clinical trial of gabapentin versus placebo for pain after sacrospinous ligament fixation. Female Pelvic Med Reconstr Surg 2022;28:65–71. https://doi.org/10.1097/spv.0000000000001064 doi: 10.1097/SPV.0000000000001064. [DOI] [PubMed]
  66. Huynh TQ, Patel NR, Goldstein ND, Makai GE. Preoperative gabapentin for minimally invasive hysterectomy: a randomized controlled trial. J Minim Invasive Gynecol 2021;28:237–44.e2. https://doi.org/10.1016/j.jmig.2020.04.040 doi: 10.1016/j.jmig.2020.04.040. [DOI] [PubMed]
  67. Ayad SS, Makarova N, Niazi AK, Khoshknabi DS, Stang T, Raza S, Kim DD. Effects of gabapentin enacarbil on postoperative pain after hip and knee arthroplasty: a placebo-controlled randomized trial. Clin J Pain 2022;38:250–6. https://doi.org/10.1097/ajp.0000000000001024 doi: 10.1097/AJP.0000000000001024. [DOI] [PubMed]
  68. Myles PS, Myles DB, Galagher W, Boyd D, Chew C, MacDonald N, Dennis A. Measuring acute postoperative pain using the visual analog scale: the minimal clinically important difference and patient acceptable symptom state. Br J Anaesth 2017;118:424–9. https://doi.org/10.1093/bja/aew466 doi: 10.1093/bja/aew466. [DOI] [PubMed]
  69. Feldheiser A, Aziz O, Baldini G, Cox BPBW, Fearon KCH, Feldman LS, et al. Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice. Acta Anaesthesiol Scand 2016;60:289–334. https://doi.org/10.1111/aas.12651 doi: 10.1111/aas.12651. [DOI] [PMC free article] [PubMed]
  70. Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E, Brunelli A, Cerfolio RJ, Gonzalez M, et al. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg 2018;55:91–115. https://doi.org/10.1093/ejcts/ezy301 doi: 10.1093/ejcts/ezy301. [DOI] [PubMed]
  71. Engelman DT, Ben Ali W, Williams JB, Perrault LP, Reddy VS, Arora RC, et al. Guidelines for perioperative care in cardiac surgery: enhanced recovery after surgery society recommendations. JAMA Surg 2019;154:755–66. https://doi.org/10.1001/jamasurg.2019.1153 doi: 10.1001/jamasurg.2019.1153. [DOI] [PubMed]
  72. Ho KY, Gan TJ, Habib AS. Gabapentin and postoperative pain – a systematic review of randomized controlled trials. Pain 2006;126:91–101. https://doi.org/10.1016/j.pain.2006.06.018 doi: 10.1016/j.pain.2006.06.018. [DOI] [PubMed]
  73. Doleman B, Heinink TP, Read DJ, Faleiro RJ, Lund JN, Williams JP. A systematic review and meta-regression analysis of prophylactic gabapentin for postoperative pain. Anaesthesia 2015;70:1186–204. https://doi.org/10.1111/anae.13179 doi: 10.1111/anae.13179. [DOI] [PubMed]
  74. Tighe PJ, King CD, Zou B, Fillingim RB. Time to onset of sustained postoperative pain relief (SuPPR): evaluation of a new systems-level metric for acute pain management. Clin J Pain 2016;32:371–9. https://doi.org/10.1097/ajp.0000000000000285 doi: 10.1097/AJP.0000000000000285. [DOI] [PMC free article] [PubMed]
  75. NHS England. NHS Tarrif 2020/21. URL: www.england.nhs.uk/pay-syst/national-tariff/ (accessed 27 July 2023).
  76. Torrance N, Veluchamy A, Zhou Y, Fletcher EH, Moir E, Hebert HL, et al. Trends in gabapentinoid prescribing, co-prescribing of opioids and benzodiazepines, and associated deaths in Scotland. Br J Anaesth 2020;125:159–67. https://doi.org/10.1016/j.bja.2020.05.017 doi: 10.1016/j.bja.2020.05.017. [DOI] [PubMed]
  77. Mattson CL, Chowdhury F, Gilson TP. Notes from the field: trends in gabapentin detection and involvement in drug overdose deaths – 23 states and the district of Columbia, 2019–2020. MMWR Morb Mortal Wkly Rep 2022;71:664–6. https://doi.org/10.15585/mmwr.mm7119a3 doi: 10.15585/mmwr.mm7119a3. [DOI] [PMC free article] [PubMed]
  78. Mayor S. Pregabalin and Gabapentin Become Controlled Drugs to Cut Deaths from Misuse. British Medical Journal Publishing Group; 2018. doi: 10.1136/bmj.k4364. [DOI] [PubMed]
  79. Bongiovanni T, Gan S, Finlayson E, Ross J, Harrison JD, Boscardin J, Steinman MA. Prolonged use of newly prescribed gabapentin after surgery. J Am Geriatr Soc 2022;70:3560–9. doi: 10.1111/jgs.18005. [DOI] [PMC free article] [PubMed]
  80. Chen C, Tighe PJ, Lo-Ciganic WH, Winterstein AG, Wei YJ. Perioperative use of gabapentinoids and risk for postoperative long-term opioid use in older adults undergoing total knee or hip arthroplasty. J Arthroplasty 2022;37:2149–57.e3. doi: 10.1016/j.arth.2022.05.018. [DOI] [PMC free article] [PubMed]
  81. Royal College of Anaesthetists. Peri-operative Quality Improvement Programme Report. 2023. URL: https://pqip.org.uk/FilesUploaded/PQIP-Report2023_Final%20version_140623.pdf (accessed 23 September 2025).
  82. National Institute for Health and Care Excellence. NICE Medical Technology Guidance 8: The VeriQ System for Assessing Graft Flow During Coronary Artery Bypass Graft Surgery. URL: www.nice.org.uk/guidance/mtg8 (accessed 30 July 2015).
  83. National Institute for Health and Clinical Excellence. Nutrition Support in Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition. Costing Report. Implementing NICE Guidance in England. NICE Clinical Guideline no. 32. URL: www.nice.org.uk/guidance/cg32 (accessed 10 November 2015).
  84. NHS Blood and Transplant. NHS Blood and Transplant Price List 2021–22. URL: https://hospital.blood.co.uk/components/portfolio-and-prices/ (accessed 17 January 2021).

RESOURCES