The purpose of our article was not to refute the effectiveness of preemptive analgesia in specific situations, ie, herniorrhaphy and tonsillectomy, which are amply supported in the literature. Our goal was to determine if preemptive analgesia was effective in midline laparotomy incisions. We agree with Drs Mackenzie and Garner that laparotomy pain from visceral manipulation may lead to increased dorsal horn activity and subsequent attenuation of preemptive attempts to block pain. This is a point we failed to mention, but the fact remains that all patients in both groups received visceral manipulation and there was no significant difference in pain control between the 2 groups.
Bourget JL. Postoperative Pain Management—Reply. Arch Surg. 1998;133(2):226. doi: