Debridement Of Burn Wounds Research Articles

Inhibition of Bromelain Activity During Enzymatic Debridement of Burn Wounds Pretreated With Frequently Used Products.

An enzyme mixture containing bromelain (NexoBrid®) was found to be suitable for enzymatic debridement of burn wounds, as determined by the criteria of patient comfort and pain, selectivity, and efficiency. Nevertheless, daily experience showed that pretreatment of burn wounds with several other clinical agents may inhibit debridement efficiency. Therefore, the current study was performed to identify those agents and evaluate their debridement inhibition capabilities. The impact of several common agents as well pH, on NexoBrid® debridement efficiency was evaluated in vitro. A collagen-based dermal substitute (MatriDerm®) was exposed to NexoBrid® in the presence of different agents of varying concentrations. Digestion was documented. The criteria used for judging digestion were independently classified by 3 investigators at least 3 times in succession. When a low concentration (1.0 mg/ml) of NexoBrid® was used, a ≥ 50% concentration of Prontosan® had an impact on enzymatic activity. Comparable results were obtained when even lower concentrations of Octenisept® (≥ 10%) were used. A 100-µmol/L concentration of copper inhibited the enzymatic activity of both a low (1.0 mg/ml) and high (10 mg/ml) concentration of NexoBrid®. Silver-sulfadiazine at concentrations of 10% and 90% inhibited the activity of 1 mg/ml NexoBrid®. No complete inhibition of NexoBrid® activity occurred at any concentration of iron. We recommend using polyhexanide-containing agents (Prontosan®) to rinse and presoak burn wounds. Pretreatment of burn wounds with agents containing silver and copper should be avoided. Experimentally, we found a partial inhibition of NexoBrid® activity at the distinct pH values of 3 and 11.

489 A Quality Improvement Project to Increase Deep Sedation for Initial Burn Wound Debridement

489 A Quality Improvement Project to Increase Deep Sedation for Initial Burn Wound Debridement

Advances in the research of dermabrasion in burn wounds

The process of burn wounds healing includes the removal of necrotic tissue, the hyperplasia of granulation tissue and epithelialization. The removal of necrotic tissue is the first step in dealing with burn wounds. Although there are a variety of adjuvant drugs for removing necrotic tissue, surgical debridement is still the main way of debridement of burn wounds. Surgical debridement of burn wounds includes escharectomy, tangential excision and dermabrasion. Escharectomy and tangential excision have been widely used in clinical practice, while dermabrasion has not been known to the majority of burns colleagues. This article summarizes the clinical application and progress of dermabrasion in burn wounds.

Impact of single dose intravenous tranexamic acid on peri-operative blood transfusion requirements in burn patients: A prospective, randomized trial

ObjectiveDebridement of burn wounds and skin graft harvesting is associated with increased peri-operative bleeding. In this study we evaluated the effectiveness of tranexamic acid in reducing blood transfusion requirements during burn wound debridement/eschar removal and skin graft harvesting in adults with major burn injuries, with the primary outcome being the total amount of intraoperative blood loss.MethodsFifty adult patients having >20% total body surface area of burn wounds, scheduled for wound debridement/eschar removal ± skin grafting after 10 days of burn injury under general anaesthesia were included. Patients were randomly allocated to receive either injection tranexamic acid 15 mg/kg diluted to 25 ml with isotonic saline over 10 min or an equal volume of only isotonic saline before induction of general anaesthesia. Venous blood gas analysis was done in the beginning and end of surgery, and then at 24 postoperative hours to assess hemoglobin levels of the patients. Blood transfusion was given when hemoglobin levels fell down to or below 7 gm/dl. Intraoperative blood loss was calculated using the Gross formula.ResultsIntraoperative blood loss was found to be significantly higher in placebo group compared to tranexamic group, 990 ± 358.9 ml vs 581 ± 333.2 ml (p < 0.00), with more blood and colloid solutions being used to replace the blood loss in placebo group (p < 0.05).ConclusionsPreoperative administration of a single dose of tranexamic acid significantly reduces blood loss during debridement of burn wounds and skin graft harvesting surgeries without increasing the risk of untoward side-effects or complications.

Enzymatic burn wound debridement with NexoBrid®: Cost simulations and investigations on cost efficiency

Abstract Aim Removal of eschar (debridement) is an essential and early step in the treatment of deep burns. Enzymatic debridement by NexoBrid® is a relatively new non-surgical tool for early, individualized and selective debridement which adds some advantages compared to surgical standard techniques known as standard of care (SOC). Nevertheless, until now it is not represented and calculated in the pricing system for German hospitals (G-DRG system), and an own operative procedure key (OPS) is lacking. The objective of this empiric cost study was to compare treatment cost of enzymatic debridement by NexoBrid® and SOC based procedures and to analyse the impact of improved burn wound care using NexoBrid® on total treatment costs of burn patients. Method The analysis is based on two different cost simulation models, the Average Outcome Model and the Defined Patient Model. Based on the results of a randomized phase III trial and treatment costs specified in the pricing system for German hospitals (G-DRG system), total costs of NexoBrid® based treatments were compared to those of SOC to determine cost saving potentials (Average outcome model). In addition, distinct burn wound treatment pathways common in clinical practice were assigned to actual treatment costs to allow economic considerations (Defined Patient Model). Results Using NexoBrid® cost savings are inversely related to the treated total burned surface area (1–15% TBSA) and directly related to the savings in burn centre stay (up to 6.5 days) (Average Outcome Model). Based on quantitative and qualitative aspects, three quarter of all cases in the range of 5% to 15% TBSA burned are in favour of NexoBrid®. Main cost drivers are LOS and ICU stay (45–80% of total costs). NexoBrid® becomes a more powerful cost driver with increasing TBSA treated. If NexoBrid® completely substitutes for SOC, the total cost per patient can be reduced by nearly 30% (treatment of 5% TBSA) or are in the range of SOC costs (treatment of 15% TBSA) (Defined Patient Model). Highest costs are generated when enzymatic and surgical methods for debridement are combined and an increased LOS or ICU stay is indicated. Conclusion Cost advantages of enzymatic debridement by NexoBrid® may emerge in cases with low or medium burned and treated surface area when costs for enzymatic debridement remain below the costs for SOC (excision plus autografting). Even in more severe cases (15% TBSA burned) total costs of basic NexoBrid®-based treatment pathways do not exceed costs of comparable SOC pathways. In addition, enzymatic debridement by NexoBrid® can be successfully applied as a strategic tool in order to reduce surgical procedure time and OR room capacity and making use of the redundant capacity for further surgical cases reimbursement. Beside these quantitative aspects that may improve overall economic efficiency, qualitative improvements of burn wound care must be considered separately from this analysis.

Application of a hydrosurgery system in debridement of various types of burn wounds

Burn wound healing is closely associated with the depth of wound and early debridement. The traditional ways of debridement have certain limitations and often result in poor appearance and function of repaired area. At present, the hydrosurgery system has been applied clinically in burn field. This paper summarizes advantages and disadvantages of application of the hydrosurgery system in debridement of burn wound with different depths, different periods, extraordinary region, and uncommon agent.

Assessment of Acute Burn Management in 32 Low- and Middle-Income Countries.

The purpose of this study is to ascertain whether acute burn management (ABM) is available at health facilities in low- and middle-income countries (LMICs). The study used the World Health Organization situational analysis tool (SAT) which is designed to assess emergency and essential surgical care and includes data points relevant to the acute management of burns. The SAT was available for 1413 health facilities in 59 countries. A majority (1036, 77.5 %) of the health facilities are able to perform ABM. The main reasons for the referral of ABM are lack of skills (53.4 %) and non-functioning equipment (52.2 %). Considering health centres and district/rural/community hospitals that referred due to lack of supplies/drugs and/or non-functioning equipment, almost half of the facilities were not able to provide continuous and consistent access to the equipment required either for resuscitation or to perform burn wound debridement. Out of the facilities that performed ABM, 379 (36.6 %) are capable of carrying out skin grafts and contracture release, which is indicative of their ability to manage full thickness burns. However the magnitude of full thickness burns managed was limited in half of these facilities, as they did not have access to a blood bank. The initial management of acute burns is generally available in LMICs, however it is constrained by the inability to perform resuscitation (19 %) and/or burn wound debridement (10 %). For more severe burns, an inability to perform skin grafting or contracture release limits definitive management of full thickness burns, whilst lack of availability to blood further compromises the treatment of major burns.

Debridement of burn wounds using a hydrosurgery system

The healing process of burn wounds is strongly associated with the depth of wounds, and the depth of wounds is dependent to initial temperature and duration of contact with source of heat, infection, and secondary damage in the debridement process. On this basis, some experts present a concept of accurate debridement, which denotes removal of all necrotic tissue and at the same time protecting viable tissue for repair of raw wounds in order to maximally maintain patients' appearance and functions. A new technology of burn wound debridement--hydrosurgery system has been applied clinically. This paper summarizes the characteristics of hydrosurgery in the aspects of its technology, suitable wounds, bacterial load, amount of blood loss, and degree of pain produced during operation, and also the author's opinions regarding its efficacy to realize an accurate debridement for burn injury.

Prospective, randomised controlled trial comparing Versajet™ hydrosurgery and conventional debridement of partial thickness paediatric burns

IntroductionConventional surgical debridement of burn wounds consists of tangential excision of eschar using a knife or dermabrasion until viable dermis or punctate bleeding occurs. The Versajet™ (Smith and Nephew, St. Petersburg, FL, USA) hydrosurgery system has also been advocated for burn wound debridement, with the suggestion that enhanced preservation of dermal tissue might reduce subsequent scarring. MethodsA prospective randomised controlled trial was undertaken comparing Versajet™ to conventional debridement. After excluding those with facial burns, 61 children ≤16 years of age undergoing debridement and skin grafting for partial thickness burns were recruited. Adequacy of debridement was assessed by 2mm punch biopsies taken pre- and post-debridement. Surgical time, percentage graft take at day 10, time to healing, post-operative infection and scarring at 3 and 6 months were assessed. ResultsThirty-one children underwent conventional debridement and 30 debridement using Versajet™. There was a significant difference in the amount of viable dermal preservation between the two groups (p=0.02), with more viable tissue lost in the conventional group (median 325μm) versus the Versajet™ group (median 35μm). There was no significant difference between graft take at day 10 (p=0.9), post-operative wound infection (p=0.5), duration of surgery (p=0.6) or time to healing after grafting (p=0.6). Despite better dermal preservation in the Versajet™ group, there was no significant difference between scarring at 3 or 6 months (p=1.0, 0.1). ConclusionsThese findings suggest that Versajet™ hydrosurgery appears a more precise method of burn wound debridement. Although dermal preservation may be a factor in reducing subsequent hypertrophic scarring, there were no significant differences found between scarring at 3 or 6 months after-injury.

Gabapentin in burns.

Dear Editor, I read with interest the article entitled Effect of Gabapentin on Morphine Consumption and Pain after Surgical Debridement of Burn Wounds: A Double-Blind Randomized Clinical Trial Study and was impressed by the scientific rigor and level of detailed observation. This is especially admirable in a study performed at the front line of burn surgery. Gabapentin appears to have a role to play in the reduction of pain and opiate usage during major burns surgery. It is worth, however, bringing the readers’ attention to another key role for the drug in burn which is not mentioned in the discussion. Gabapentin also has an important role in the management of burn-induced itch. Evidence is emerging that it is more effective than conventional treatments such as antihistamines and should be considered a first-line treatment in burn patients (1). Taking this research on gabapentin in perioperative pain to the bedside and introducing gabapentin early in the treatment process for analgesia may help to prevent the transition from pain to itch that so frequently occurs during the healing process in these patients.

Innovative Use of Povidone-Iodine to Guide Burn Wound Debridement and Predict the Success of Biobrane as a Definitive Treatment for Burns

The success of Biobrane (Smith & Nephew, St. Petersburg, Florida) dressing in superficial burns depends on wound selection and preparation. After wound debridement, povidone-iodine is applied, and changes in wound color are recorded. Next, Biobrane is applied, and adherence is checked after 48 hours. The authors' study showed that remaining brown areas of the wound are predictive of Biobrane nonadherence, which is indicative of deeper burns.

Retrospective analysis of burn injuries caused by hot milk in 159 pediatric patients: 14 years of experience in a burn unit.

The aim of this study was to investigate the hot milk burns among the pediatric patients and to compare our experiences with similar studies in the literature. A 14-year retrospective study was conducted on 159 pediatric patients with hot milk burn who hospitalized at the Burn Unit of Erciyes University Medical Faculty. There were 81 male and 78 female patients with a male to female ratio of 1.03:1. The mean age of the patients was 2.7±1.6 years. The initial injury was immersion in 59.7% of the patients and spillage in 40.3%. The mean burned body surface area of the patients was 18.6±10.8%. Twenty-two percent of the patients had moderate, and 78% had major burn trauma. Forty-nine percent of the patients received burn wound debridement and reconstruction with auto-skin grafts. Our burn unit's mortality rate was 1.5% among 542 pediatric patients with hot water, and 5.6% among 159 pediatric patients with hot milk burn during the same period, respectively. Hot milk burns should be considered as separately from other hot liquid burns which do not contain fat such as water, tea, and coffee. Physical and chemical properties of milk because of its high content of fat give rise to more tissue destruction, increased morbidity and mortality.

English

Introduction Burn injuries are often considered to be one of the most physically and psychologically damaging experiences an individual may endure. Because of this, more treatment options for managing pain and distress during burn wound debridement are needed. When used in combination with traditional treatment, medical hypnosis may offer health-care professionals an option for meeting the needs of patients with burn wounds. This article offers a critical review of the literature currently available on the efficacy of medical hypnosis for managing pain and distress during wound debridement and offers suggestions for an improved methodology for future trials. Materials and Methods MEDLINE, PsycINFO, Psyc ARTICLES, HealthSource: Nursing Edition, PubMed and Google Scholar were searched using the keywords ‘hypnosis’, ‘burn wounds’, ‘pain’ and ‘debridement’. Additional articles were selected from the bibliographies of representative literature. All experimental and quasi- experimental studies investigating the efficacy of hypnosis for managing pain and psychological distress during wound debridement were included in our results. Results Six studies involving a total of 217 participants met our inclusion criteria. The results of these studies suggest that hypnosis may be more effective than structured attention for reducing patients’ pain and anxiety levels during wound debridement. However, results are inconclusive due to oversights in study design, and additional studies that correct these design flaws are needed. Conclusion The existing evidence suggests that medical hypnosis may be effective in managing pain and distress for burn victims who have difficulty coping during wound debridement. Further investigation is warranted.

Repeated Use of Immersive Virtual Reality Therapy to Control Pain During Wound Dressing Changes in Pediatric and Adult Burn Patients

The current study explored whether immersive virtual reality (VR) continues to reduce pain (via distraction) during more than one wound care session per patient. Thirty-six patients aged 8 to 57 years (mean age, 27.7 years), with an average of 8.4% TBSA burned (range, 0.25-25.5 TBSA) received bandage changes, and wound cleaning. Each patient received one baseline wound cleaning/debridement session with no-VR (control condition) followed by one or more (up to seven) subsequent wound care sessions during VR. After each wound care session (one session per day), worst pain intensity was measured using a visual analog thermometer, the dependent variable. Using a within-subjects design, worst pain intensity during wound care with no-VR (baseline, day 0) was compared with pain during wound care while using immersive VR (up to 7 days of wound care during VR). Compared with pain during no-VR baseline (day 0), pain ratings during wound debridement were statistically lower when patients were in VR on days 1, 2, and 3, and although not significant beyond day 3, the pattern of results from days 4, 5, and 6 are consistent with the notion that VR continues to reduce pain when used repeatedly. Results from the present study suggest that VR continues to be effective when used for three (or possibly more) treatments during severe burn wound debridement.

Enzymatic debridement of large burn wounds with papain–urea: Is it safe?

IntroductionEnzymatic debridement is a method by which burn wounds can be prepared for coverage by skin grafts in patients presenting late. Many agents have been used in the past but none of them have been thoroughly evaluated. The present study was undertaken to assess the efficacy of Debridace, a commonly available debriding agent with papain and urea as its constituents. Material and methodsA prospective descriptive study design was used to evaluate our experience. Almost symmetrical areas of the burnt surface were assessed and used for comparison. On one half of the wound, Debridace was applied while on the other silver sulphadiazine was used. The primary end point of this study was the extent of the achieved debridement at the end of the study period. Secondary outcomes were the presence of adverse effects such as pain and fever. All patients with sepsis were excluded from the study. ResultsThe age of the subjects ranged from 9 to 80 years with an SD of 16. Large areas ranging from 5% to 20% body surface area with an SD of 4.27 were debrided by Debridace. Only two patients (3.33%) could complete the study. The rest of the recruited patients either had high fever (63.33%), excruciating pain (13.33%) or both (16.66%), which brought an end to enzymatic debridement. ConclusionDebridace, a papain–urea product, cannot be considered safe as an enzymatic debriding agent in its present form for use in major burn patients who present late with deep burn wounds that are large in size.

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

Background 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. Objectives 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. Patients and Methods Results All the enrolled patients were able to complete the study; therefore, data from 50 patients wereanalyzed. 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. Conclusions 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.

Control of Pain After Surgical Debridement of Burn Wounds

Dear Editor, We read with interest your article on the use of gabapentin pain control after burn debridement (1). Gabapentin has a well-established role in the management of neuropathic pain, and has been investigated in the past decade regarding its ability to potentiate the effect of morphine on postoperative pain, or decrease the amount of pain experienced by patients after surgery. This study represents one of the only randomized, placebo-controlled, double-blind studies to look at gabapentin in burn patients. The authors found that 1200mg of gabapentin 2 hours prior to operative debridement of burn wounds led to a significant decrease in pain in the immediate 24-hour postoperative period, as measured by the visual analog score and by patient-requested morphine consumption. While the results are important and consistent with the growing body of literature, there remain methodological questions that are not addressed (2-4). First, while the authors state that total burn surface area in all patients were comparable (average of 13% ± 25 in the placebo group versus 19% ± 29 in the gabapentin group), there are several additional characteristics that can significantly affect pain, both pre-and post-operatively. Burn severity, type of burn (flame, chemical) and location on the body are not addressed here. In addition, the extent of debridement must also be considered, with regard to both surface area and depth. Conditions such as infection or other complicating medical conditions are also not mentioned in the article, which can be common in burn patients, and which can significantly affect patient outcome. Secondly, neuropathic pain induced by burns can lead to chronic and debilitating pain; this should be evaluated, depending on the feasibility of follow-up. The authors state that “Fassoulaki et al. (5) were unable to demonstrate a decrease in analgesic consumption and VAS scores at rest or after movement during the first 24h after the operation” due to “differences in the types of surgeries performed.” In fact, however, Fassoulaki et al. (5) were able to find that gabapentin reduced requirement for analgesics and led to decreased pain with movement within the first week post-operatively; the caveat was that this difference did not persist long-term (at 10 days or 3 months). Because chronic pain control can be such an important aspect of clinical outcomes in burn patients, this is critical to consider when thinking about impact on changes in management. In summary, this study provides important support for the use of gabapentin in postoperative pain, and represents one of the only studies to address its use in burn patients. However, several questions regarding the clinical condition of patients (burn severity, type of burn, location of burn, extent of debridement, and presence of infection) must be considered; long-term sequelae with regard to chronic pain must also be addressed. All of these variables must be taken into account before the true impact of gabapentin in these patients can be determined.

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

Background: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.Objectives: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.Patients and Methods:In a randomized, double-blind, placebo-controlled study, 50 burn patients received a single oral dose of gabapentin (1200mg) or placebo 2h before surgery. Anesthesia was induced with propofol and fentanyl and maintained by infusingpropofol, remifentanil, and 50% N2O in O2. 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.Results:All the enrolled patients were able to complete the study; therefore, data from 50 patients wereanalyzed. 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.Conclusions: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.

The Use of Gabapentin to Decrease Morphine Consumption After Surgical Debridement for Burns

I read with great interest the recent manuscript by Siamak Rimaz on “ Effect of Gabapentin on Morphine Consumption and Pain after Surgical Debridement of Burn Wounds: A Double-Blind Randomized Clinical Trial Study” published in Archives of Trauma Research (1). In this article they recruited 50 patients and through a randomized, double-blind, placebo-controlled study demonstrated a significant improvement in pain scores and clinical parameters after administration of a single oral dose of 1200mg gabapentin. The family of opioid analgesics has been the backbone of analgesia in burn patients. However, it is well known that this group of drugs tend to have numerous side effects and recent data has implicated them as being capable of inducing pain N-methyl-D-aspartate (NMDA) receptor antagonists such as ketamine and gabapentin have recently became popular due to the marked opiate sparing effects. The effect of pain modulation on the descending pathways with the use of gabapentin has been shown in numerous studies (2, 3). Indeed I believe that the pain post-mastectomy is different from a post surgical debridement of burn wounds, accounting for the difference in clinical results in studies comparing the effect of gabapentin in different procedures. The authors have recorded down respiratory rate as one of the clinical indicators of pain. Despite no significant difference was demonstrated between the gabapentin group and the placebo group, I note that there was a decrease in respiratory rate at all-time points in the gabapentin group. I understand the rational of using these parameters as a mean in recording pain but would one not expect the increased use of opiates in the placebo group to result in a greater influence on respiratory depression? It would be worth commenting on this. Lastly, the authors have focused on the analgesic effect of gabapentin in burn patients. However, it would worth to mention the effect of Please cite this paper as: Ee G, Ho R. The Use of Gabapentin to Decrease Morphine Consumption After Surgical Debridement for Burns. Arch Trauma Res. 2012; 1(2):83-4. DOI: 10.5812/atr.6468

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

Dear Editor, We read with interest the article by Rimaz and coworkers about the beneficial effect of preoperative oral administration 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 trials published by Ho and coworkers has shown that, in different 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 published studies. Indeed, as highlighted by Turan and coworkers, 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 serious 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 interesting systematic review published by Mathiesen et al. focused on the use of gabapentin in the preoperative period 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 the use in other sort of surgeries revealed no significant results. In addition, a reduction in pain scores was demonstrated 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 promising 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 preoperative 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 anti-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 gabapentin, looking for the lowest effective dose.