Gabapentin is a medication primarily prescribed to manage certain types of nerve pain and to control partial seizures. This drug functions by reducing the excitability of nerve cells in the brain and spinal cord. Given its action on the central nervous system, questions about its safety when combined with anesthesia and surgical procedures are common. The decision to take any medication, including gabapentin, the night before surgery requires careful, individualized medical guidance.
Standard Pre-Surgical Medication Guidelines
The general rule for preparing for surgery involves strict adherence to medication guidelines established by the surgical and anesthesia teams. One of the most important instructions is “nil per os” (NPO), which means nothing by mouth, including food and most liquids, for a set period before the procedure. Medications are often categorized based on their potential to interfere with the surgical process or recovery.
Drugs that affect blood clotting, such as non-steroidal anti-inflammatory drugs (NSAIDs), are typically stopped days or even a week prior to minimize the risk of excessive bleeding. Medications that significantly affect blood pressure, blood sugar, or central nervous system function are also closely scrutinized. However, certain essential medications, like those for heart conditions or high blood pressure, are frequently allowed on the morning of surgery with a small sip of water.
The goal of these pre-operative guidelines is to ensure the patient’s physiology is as stable and predictable as possible for the anesthesiologist. Gabapentin falls under intense scrutiny because it alters neurological function, placing it in a category that requires specific instructions rather than following a blanket rule.
Gabapentin’s Interaction with Anesthesia
The primary concern regarding gabapentin use before surgery stems from its classification as a central nervous system (CNS) depressant. Gabapentin works by modulating the nervous system, resulting in effects like sedation, dizziness, and somnolence.
When gabapentin is present in the system, its sedative effects can be amplified by general anesthesia and the opioid pain relievers used during and after the procedure. The combination increases the risk of respiratory depression—a shallow or slow breathing rate that can lead to low oxygen levels. This synergistic effect can also make it more difficult for the anesthesiologist to accurately adjust the dosage of anesthetic agents needed to keep the patient asleep.
Studies on older adults who received perioperative gabapentin have also shown an increased risk of adverse outcomes like delirium, new antipsychotic use, and pneumonia in the days following major surgery. These effects are often dose-dependent, meaning a higher pre-operative dose carries a greater risk of excessive sedation and postoperative confusion. The increased propensity for somnolence and dizziness can also delay the patient’s discharge from the post-anesthesia care unit.
When Continuing the Medication is Necessary
Despite the risks of interaction, the medical team may determine that continuing gabapentin is necessary for the patient. For individuals who take the medication to control a seizure disorder, abruptly stopping the drug can trigger breakthrough seizures, posing a threat to recovery. Patients using gabapentin for chronic neuropathic pain may experience pain escalation or withdrawal symptoms if the medication is suddenly discontinued.
When a patient’s need for the medication is considered non-negotiable, the medical team conducts a thorough risk assessment. This process weighs the danger of an adverse interaction with anesthesia against the risk of the underlying condition worsening without the drug. In such cases, the medication may be continued, often at the usual dose or sometimes a reduced dose, under the direct instruction of the anesthesiologist or surgeon.
In some surgical settings, a single, lower dose of gabapentin (such as 300 mg to 600 mg) is intentionally given one to two hours before surgery as part of a multimodal pain management strategy. This pre-emptive use aims to reduce the patient’s pain and decrease the amount of opioid medication needed after the procedure. When gabapentin is used this way, the anesthesia team is fully aware and accounts for its effects during the administration of general anesthesia.
Mandatory Consultation Before Surgery
The decision to take gabapentin the night before surgery is not a choice a patient should make alone. The ultimate protocol is highly individualized and must be determined by the surgical care team, primarily the anesthesiologist and the operating surgeon. Patients must contact the pre-operative clinic or the surgeon’s office as soon as possible to discuss their full medication list.
During this mandatory consultation, the patient must provide specific details, including the exact dosage, the time the last dose was taken, and the specific reason for taking the medication. The medical team will use this information to determine the final instruction: either to hold the dose, take a reduced dose, or continue the medication as prescribed. Patients should never unilaterally stop or continue their gabapentin regimen, as either action can introduce risks to the surgical outcome and recovery.