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Department of Anaesthesiology; Sanjay Gandhi Postgraduate Institute of Medical Sciences; Lucknow, India; ckpandey{at}sgpgi.ac.in
To the Editor:
Postoperative dysesthetic pain, while usually mild and transient, may be severe, persistent, and debilitating. We present a case of refractory postoperative dysesthetic pain managed successfully with gabapentin.
A 56-yr-old male underwent open cholecystectomy 9 yr ago. He was asymptomatic until 4 yr ago, when he developed mild burning pain at the surgical site. The pain became severe during the next 6 mo. Paracetamol and diclofenac reduced his pain initially, but over time the pain became refractory. We tried combining different classes of drugs (cyclooxygenase-2 inhibitor, tramadol, vitamin supplements, anxiolytic, and tricyclic antidepressant), but none were effective. We advised the patient to have an intercostal nerve block or scar excision. At the preanesthetic check-up his visual analog pain score was 8/10. We started the patient on gabapentin for a week before surgery, starting at 300 mg once per day and ending with 300 mg 3 times per day. The patient’s visual analog pain score decreased from 8/10 to 3/10 during that week. Further dose escalation to 600 mg 3 times a day rendered the patient pain-free. We have continued this treatment for the last 6 mo, and his pain has not recurred.
Dysesthetic pain is caused by entrapment of sensory nerves within scar tissue. Although most dysesthetic pain resolves spontaneously, when it persists, the quality of a patient’s life diminishes (1). Therapeutic options are typically limited and often result in adverse effects. Gabapentin has been used successfully to manage neuropathic painful states (2–4). Its successful use in our patient’s case further substantiates its efficacy. Because gabapentin is generally well tolerated and does not including dependence, we recommend trying it in cases of refractory postoperative dysesthetic pain before opting for more invasive procedures.
REFERENCES
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