Key PointsQuestionIs postoperative use of gabapentinoids, a medication framed as opioid sparing, increasing, and is gabapentinoid use associated with decreased opioid prescribing among older adults?FindingsIn this serial cross-sectional study of postoperative pain medication prescribing for common surgical procedures in 494 922 Medicare recipients, gabapentinoid prescribing increased over a 5-year period from 2% to 5%. In this same period, opioid prescribing increased from 56% to 59%, as did concomitant prescribing.MeaningThese findings suggest that postoperative gabapentinoid prescribing for older adults is rising in addition to rather than instead of opioid use, a combination recommended to be avoided in older adults.