Preoperative Gabapentin in Pediatric Anterior Cruciate Ligament Reconstruction With Peripheral Nerve Blockade: A...

Background Preoperative gabapentin has been shown to reduce postoperative pain and opioid consumption following anterior cruciate ligament reconstruction (ACLR) in adult patients treated with local infiltration analgesia. Its effectiveness in pediatric patients receiving peripheral nerve blockade for ACLR remains unclear. Methods We conducted a retrospective, single-center cohort study of pediatric patients (<18 years) undergoing ACLR from 2019 to 2024. All patients received anterior sciatic and adductor canal peripheral nerve blocks. Patients were stratified by receipt of preoperative gabapentin. The primary outcome was total postoperative opioid usage prior to hospital discharge (morphine milligram equivalents, MME). Secondary outcomes included pain scores, sedation, block efficacy, and length of stay. Multivariable linear regression was performed adjusting for patient demographics, intraoperative opioid usage, anesthesiologist, and tourniquet time. Results A total of 79 patients were enrolled in the study, with 55 in the Gabapentin group and 24 in the No Gabapentin group. Postoperative opioid consumption was low and not significantly different between groups (Gabapentin 4.1 ± 9.2 vs No Gabapentin 5.2 ± 5.7 MME, p=0.08). In adjusted analysis, preoperative gabapentin was not associated with postoperative opioid use (β = -0.56, p=0.25). Pain scores, sedation, block efficacy, and length of stay were similar between groups. Intraoperative opioid use was significantly higher in the Gabapentin group (p<0.001). Nearly one-third of patients required no postoperative opioids prior to discharge. Conclusions Preoperative gabapentin was not associated with a detectable reduction in postoperative opioid use or improvement in pain control in pediatric ACLR patients receiving adductor canal and anterior sciatic peripheral nerve blocks. When highly effective regional anesthesia is employed, gabapentin may provide limited incremental benefit.