Gabapentinoids are widely used in the perioperative period for acute pain management, yet the clinical benefit is uncertain. In this issue of Anesthesiology, Verret et al. present a systematic review and meta–analysis analyzing the analgesic efficacy and adverse events with the perioperative use of gabapentinoids in adult patients. In an accompanying Editorial, Kharasch et al. review the evolution of use of perioperative gabapentinoids and conclude that evidence-based practice impels revising if not eliminating the routine use of perioperative gabapentinoids in adults. Cover Illustration: A. Johnson, Vivo Visuals.