I recently dove into the article “Perioperative Management for Complex Spine Fusion Surgery” by Carabini et al., featured in the February 2024 issue of Anesthesiology,1  and I have to say, it really grabbed my attention. Not only does it offer valuable insights into improving the management of acute postoperative pain, but it also drives home a crucial point. I strongly believe that the article could enhance its service to readers in the field of anesthesiology by giving more weight to the limited effectiveness and potential risks associated with gabapentinoids. Previous research, highlighted in a meta-analysis of 281 randomized controlled trials involving gabapentinoids versus placebo in patients undergoing surgery (including 6,549 patients undergoing orthopedic or spinal surgeries), found no clinically significant differences in pain intensity compared to placebo.2  Therefore, it is essential to exercise caution when considering their use in complex spine surgery, given the lack...

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