The importance of perioperative administration of an anti-hyperalgesic drug in burn wounds

Dalle Carbonare, L.

Sandri, M.

Schweiger, V.

Archives of Trauma Research

PubMed

Luca Dalle Carbonare

Micol Sandri

Vittorio Schweiger

Crossref

The Importance of Perioperative Administration of an Anti-Hyperalgesic Drug in Burn Wounds

DALLE CARBONARE, Luca Giuseppe

M. Sandri

SCHWEIGER, Vittorio

Catalogo dei prodotti della ricerca

kashan university of medical sciences

Research
 Archives of 
The Importance of Perioperative Administration of an Anti-Hyperalgesic Drug in Burn Wounds
Luca Dalle Carbonare 1*, Micol Sandri 2, Vittorio Schweiger 2
1 Department of Medicine, Clinic of Internal Medicine, University of Verona, Verona, Italy2 Intensive Care and Pain Therapy Centre, Department of Surgical Sciences, University of Verona, Verona, Italy
* Corresponding author: Luca Dalle Carbonare, Department of Medicine, Clinic of Internal Medicine, University of Verona, Verona, Italy. Tel.: +39-0458124684, Fax: +39-0458027496, E-mail: luca.dallecarbonare@univr.it 
c  2012, Kashan University of Medical Sciences. Published by kowsar This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which per-mits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
A R T I C L E  I N F O
Article history:Received: 17 Jul 2012Revised: 07 Aug 2012Accepted: 05 Sep 2012
Keywords:BurnsWoundsPain
Article type:Letter 
Published by Kowsar, 2012. cc 3.0.
 Please cite this paper as: Dalle Carbonare L, Sandri M, Schweiger V. The Importance of Peri-operative Administration of an Anti-Hyperalgesic Drug in Burn Wounds. Arch Trauma Res. 2012:1(3): 139-40. DOI:10.5812/atr.7451 
Dear Editor, 
We read with interest the article by Rimaz and cowork-ers about the beneficial effect of preoperative oral admin-istration of a high single dose (1200 mg) of gabapentin on postoperative pain scores and morphine consumption in patients undergoing surgical debridement of burn wounds (1). The effect of preoperative administration of oral gabapentin in order to reduce postoperative pain scores and opioid consumption was analyzed in several studies. A systematic review of randomized controlled tri-als published by Ho and coworkers has shown that, in dif-ferent types of surgery, the preoperative administration of a single dose of 1200 mg oral gabapentin produced a significant reduction in pain intensity at rest compared with placebo in the early and late postoperative period at 6 and 24 h after administration, respectively. In addition, some similar studies showed a significant reduction in opioid consumption and a delayed request for analgesia 
(2). As regard to the adverse effects, the administration of 1200 mg of oral gabapentin did not show significant differences with respect to placebo in a large part of pub-lished studies. Indeed, as highlighted by Turan and co-workers, the treatment group showed fewer episodes of vomiting and urinary retention, probably due to lower consumption of opioids in the postoperative period (3). However, administration of a single dose of 1200 mg of oral gabapentin in the preoperative period showed no se-rious adverse effects in the treated patients. The analysis of available data has revealed a number of limitations, in particular due to the different type of surgery. An inter-esting systematic review published by Mathiesen et al. focused on the use of gabapentin in the preoperative pe-riod in relation to the surgical procedures. Reported data showed that preoperative gabapentin administration in different dosages appears to be particularly effective in reducing postoperative opioid consumption particularly after abdominal hysterectomy and spinal surgery, while 
Arch Trauma Res. 2012;1(3)140
Dalle Carbonare L et al. Anti-Hyperalgesic Drug in Burn Wounds
the use in other sort of surgeries revealed no significant results. In addition, a reduction in pain scores was dem-onstrated mostly in early postoperative period, probably due to higher gabapentin plasmatic level in the early postoperative phase (4). At a single preoperative oral dose of 1200 mg, gabapentin showed conflicting results in relation to different types of surgeries, with promis-ing evidences only in abdominal hysterectomy, spinal surgery, radical mastectomy, thyroid and ear-nose throat surgery. However, these results should be confirmed by further investigations using the same methodology, in particular with respect to the type of anesthesia and rescue analgesia in the postoperative period. Currently, there are no other publications on the use of preopera-tive gabapentin in postoperative pain in burned patients.  In this regard, we agree with the authors that the burn wounds, in relation to the particular type of damage, may benefit from perioperative administration of an an-ti-hyperalgesic drug. In fact, some nerve endings of skin nociceptors after burns are still intact or only partially injured and continue to generate pain impulses leading to primary hyperalgesia (5). However, further studies are needed to confirm these results, especially focused on the dose-response relationship of preoperative gabapen-
tin, looking for the lowest effective dose.
Authors’ ContributionDrafting of the manuscript: Micol Sandri and Vittorio Schweiger Conception and critical revision of the manu-script: Luca Dalle Carbonare.
Financial DisclosureThe authors have no financial interests related to the material in the manuscript.
References1. Rimaz S, Emir Alavi C, Sedighinejad A, Tolouie M, Kavosi S, Kooch-akinejad L. Effect of Gabapentin on Morphine Consumption and Pain after Surgical Debridement of Burn Wounds: A Double-Blind Randomized Clinical Trial Study. Arch Trauma Res. 2012;1(1):38-43.2. Ho KY, Gan TJ, Habib AS. Gabapentin and postoperative pain--a systematic review of randomized controlled trials. Pain. 2006;126(1-3):91-101.3. Turan A, Karamanlioglu B, Memis D, Hamamcioglu MK, Tuke-nmez B, Pamukcu Z, et al. Analgesic effects of gabapentin after spinal surgery. Anesthesiology. 2004;100(4):935-8.4. Mathiesen O, Moiniche S, Dahl JB. Gabapentin and postoperative pain: a qualitative and quantitative systematic review, with fo-cus on procedure. BMC Anesthesiol. 2007;7(6).5. Latarjet J, Choinere M. Pain in burn patients. Burns. 1995;21(5):344-8.


Analgesic effects of gabapentin after spinal surgery.

Effect of Gabapentin on Morphine Consumption and Pain after Surgical Debridement of Burn Wounds: A Double-Blind Randomized Clinical Trial Study. Arch Trauma Res.

Gabapentin and postoperative pain-a systematic review of randomized controlled trials.

Gabapentin and postoperative pain: a qualitative and quantitative systematic review, with focus on procedure.

Pain in burn patients.

The Importance of Perioperative Administration of an Anti-Hyperalgesic Drug in Burn Wounds

Abstract

Similar works

Full text

Available Versions

Crossref

Catalogo dei prodotti della ricerca

kashan university of medical sciences