Résumé
Burn pain is recognized as being maximal during therapeutic procedures, and wound debridement can be more painful than the burn injury itself. Uncontrolled acute burn pain increases the stress response and the incidence of chronic pain and associated depression. Although opiates are excellent analgesics, they do not effectively prevent central sensitization to pain. The anticonvulsant gabapentin has been proven effective for treating neuropathic pain in large placebo-controlled clinical trials. Experimental and clinical studies have demonstrated antihyperalgesic effects in models with central neuronal sensitization. It has been suggested that central neuronal sensitization may play an important role in postoperative pain. The aim of this study was to investigate the effect of gabapentin on morphine consumption and postoperative pain in burn patients undergoing resection of burn wounds. In a randomized, double-blind, placebo-controlled study, 50 burn patients received a single oral dose of gabapentin [1200mg] or placebo 2 h before surgery. Anesthesia was induced with propofol and fentanyl and maintained by infusing propofol, remifentanil, and 50% N[2]O in O[2]. All patients received patient-controlled analgesia with morphine at doses of 2.5 mg bolus and a lock-out time of 10 min for 24h before the operation. Pain was assessed on a visual analog scale [VAS] at rest and during movement at 1,4,8,12,16,20, and 24 h before the operation. Heart rate, oxygen saturation, mean arterial blood pressure, respiratory rate, sedation score, and morphine consumption were studied. All the enrolled patients were able to complete the study; therefore, data from 50 patients were analyzed. The VAS scores at rest andduring movement at 1,4,8,12,16,20, and 24 h after the operation were significantly lower in the gabapentin group than in the placebo group [P < 0.05]. Morphine consumption was significantly lessr in the gabapentin group than in the placebo group [P < 0.05]. Sedation scores were similar in the 2 groups at all measured times. There were no differences in adverse effects between the groups. A single oral dose of 1200mg gabapentin resulted in a substantial reduction in postoperative morphine consumption and pain scores after surgical debridement in burn patients