A total of 252 patients undergoing lumbar spine fixation for spinal stenosis were randomized to receive either placebo (n=28) or gabapentinoids: pregabalin (75 mg or 150 mg, single or 3-day dosing) or gabapentin (300 mg or 600 mg, single or 3-day dosing). The primary outcome was postoperative pain measured via the visual analog scale (VAS) at 1, 6, 12, and 24 hours. Secondary outcomes included complications such as sedation, dizziness, and visual disturbances. Overall, the study revealed that single, high-dose gabapentin (600 mg) significantly reduced postoperative pain across all time points with minimal complications. Single, high-dose pregabalin (150 mg) was similarly effective but with a slightly increased risk of complications. Long-term, high-dose use of either gabapentinoid increased complications. These findings suggest that single, high-dose gabapentin is most effective and safe for acute postoperative pain control.