Gabapentin is an accepted agent for the treatment of neuropathic pain, but is becoming increasingly popular as an opioid-sparing agent and premedication for opioid-tolerant patients or those expected to have high levels of postoperative pain.In our institution we have treated two cases of severe respiratory depression in elderly patients in the setting of working regional analgesia, one while awaiting acute orthopaedic surgery and one post-operatively. Notably, both had obstructive sleep apnoea. They had each been administered 300 mg of gabapentin, despite the fact that their opioid use had ceased because of efficacious continuous regional analgesia. This is in keeping with results of two studies that show no benefit of gabapentin for early postoperative pain in the presence of effective regional analgesia.
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