In Reply:—

Dr. Hepner rightly calls attention to the misuse of the word “preemptive.” In our study,1we suggested in the title that morphine-6-glucuronide (M-6-G) lacks preemptive analgesic effect. From a semantic point of view, we agree with Dr. Hepner’s comment because M-6-G was administered after the start of surgery. Nevertheless, we stress that most anesthesiologists use central analgesics in combination with intravenous general anesthetics at induction of anesthesia. Thus, in our routine practice, preemptive analgesia is commonly used without deliberate intention.

Motamed C, Mazoit X, Ghanouchi K, Guirimand F, Abhay K, Lieutaud T, Bensaid S, Fernandez C, Duvaldestin P: Preemptive intravenous morphine-6-glucuronide is ineffective for postoperative pain relief. ANESTHESIOLOGY 2000; 92:355–60