Correspondence  |   June 2003
Gabapentin: The First Preemptive Anti-Hyperalgesic for Opioid Withdrawal Hyperalgesia?
Author Affiliations & Notes
  • Burkhard Gustorff, M.D., D.E.A.A.
  • *Department of General Anaesthesiology and Intensive Care, University of Vienna, Vienna, Austria.
Article Information
Correspondence   |   June 2003
Gabapentin: The First Preemptive Anti-Hyperalgesic for Opioid Withdrawal Hyperalgesia?
Anesthesiology 6 2003, Vol.98, 1520-1521. doi:
Anesthesiology 6 2003, Vol.98, 1520-1521. doi:
To the Editor:—
It was with great interest that we read the study of Dirks et al.  , who found a substantial reduction in postoperative morphine consumption over 4 h after remifentanil-based anesthesia for radical mastectomy by preoperative application of a single dose of 1200 mg oral gabapentin. 1 The authors suggested either a potential effect of gabapentin on acute pain or the potential modulation of intraoperative induction of opioid tolerance. In an accompanying editorial, Gilron pointed out the vast analgesic potency of gabapentin in humans. 2 
However, in a human inflammatory pain model, 1200 mg gabapentin reduced neither the primary hyperalgesia to heat nor the secondary hyperalgesia to pinprick. 3 In the human heat-capsaicin model, 1200 mg gabapentin reduced the secondary hyperalgesia to pinprick but did not affect the primary hyperalgesia response. 4 Hence, in accordance with studies in chronic pain, 5,6 gabapentin provides antihyperalgesic but not antinociceptive properties. Postoperative pain, however, is predominantly nociceptive in origin.
Dirks et al.  performed high-dose remifentanil-based anesthesia using 0.4 μg/kg/min. It is well known that opioids may induce hyperalgesia. 7 In particular the transition from short-acting opioids may be accompanied by hyperalgesia. 8 Because remifentanil does not induce acute opioid tolerance, 9 an increase in postoperative morphine consumption after high-dose remifentanil-based anesthesia may be explained by the development of opioid withdrawal hyperalgesia. 10 
Dirks et al.  studied only the immediate postoperative stage for a period of 4 h. Any information about the postoperative morphine consumption over the first 24 h is lacking. Taken together they may, therefore, have studied remifentanil withdrawal induced hyperalgesia after mastectomy. Thus we suggest that gabapentin may not be a “broad-spectrum” analgesic for postoperative pain therapy, but rather the first effective antihyperalgesic drug for the preemptive treatment of transient hyperalgesia after short-acting opioid-based anesthesia. Further studies are needed to test this fascinating aspect of gabapentin.
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