This Article Résumé de cet Article Full Text Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Weinbroum, A. A. Articles by Szold, A. Search for Related Content PubMed PubMed Citation Articles by Weinbroum, A. A. Articles by Szold, A.

Dextromethorphan attenuation of postoperative pain and primary and secondary thermal hyperalgesia

Avi A. Weinbroum, MD^*,, Alexander Gorodezky, MD, David Niv, MD, Ron Ben-Abraham, MD^*, Valery Rudick, MD and Amir Szold

^* From the Post-Anesthesia Care
and the Pain Control Units,
the Endoscopic Surgery Service
and the Department of Anesthesiology and Critical Care Medicine, Tel Aviv Sourasky Medical Center, and the Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel.

Address correspondence to: Dr. Avi A. Weinbroum, Director, Post Anesthesia Care Unit Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv 64239, Israel. Phone: +972-3-697-3237; Fax: +972-3-692-5749; E-mail: draviw{at}tasmc.health.gov.il

Purpose: To determine the effect of 90 mg dextromethorphan (DM) po vs placebo 90 min preoperatively, on the immediate and delayed postoperative course.

Methods: Thirty patients undergoing laparoscopic cholecystectomy or inguinal hernioplasty under general anesthesia were studied. Half (DM) received 90 mg dextromethorphan and half received placebo 90 min before anesthesia. Intravenous Patient Controlled Aanalgesia with morphine was available for two hours within a six-hour observation period; 75 mg diclofenac im prn was given later in PACU and on-ward (24 hr). Pain was assessed using the visual analogue scales. Thermal thresholds for cold and hot sensation and for pain (by limit method) were evaluated at the site of skin incision (primary-) and distantly (secondary hyperalgesia). Von Frey filaments were applied testing touch sensation. Sedation level and morphine consumption were also assessed in PACU.

Results: Demographic, surgical and perioperative parameters were similar; no untoward effects were encountered. Pain intensity and sedation were lower, and the feeling of well-being was greater, in the DM patients: one vs five (median), two vs five, five vs two, respectively, P <0.01 (90 min time-point). Thermal application revealed absence of primary and secondary hyperalgesia only in the DM patients; von Frey filaments induced similar pain sensation in both groups. Mean morphine/group, morphine/weight and diclofenac injection rates were ~55% lower in the DM group: 2.1 ± 1.2 (SD) vs 4.7 ± 2.3, 0.03 ± 0.02 vs 0.07 ± 0.03, 1.0 ± 0.3 vs 2.4 ± 0.2, respectively, P <0.01.

Conclusions: Compared with placebo, DM enabled reduction of postoperative analgesics consumption, improved well-being, and reduced sedation, pain intensity and primary and secondary thermal hyperalgesia.

This article has been cited by other articles:

				R. Leonard and H. Kourlas Too Much of a Good Thing? Treating the Emerging Syndrome of Opioid-Induced Hyperalgesia Journal of Pharmacy Practice, April 1, 2008; 21(2): 165 - 168. [Abstract] [PDF]

				P. F. White The Changing Role of Non-Opioid Analgesic Techniques in the Management of Postoperative Pain Anesth. Analg., November 1, 2005; 101(5S_Suppl): S5 - 22. [Abstract] [Full Text] [PDF]

				A. A. Weinbroum, B. Bender, A. Nirkin, S. Chazan, I. Meller, and Y. Kollender Dextromethorphan-Associated Epidural Patient-Controlled Analgesia Provides Better Pain- and Analgesics-Sparing Effects than Dextromethorphan-Associated Intravenous Patient-Controlled Analgesia After Bone-Malignancy Resection: A Randomized, Placebo-Controlled, Double-Blinded Study Anesth. Analg., March 1, 2004; 98(3): 714 - 722. [Abstract] [Full Text] [PDF]

				D. M. A. Choi, A. P. Kliffer, and M. J. Douglas Dextromethorphan and intrathecal morphine for analgesia after Caesarean section under spinal anaesthesia Br. J. Anaesth., May 1, 2003; 90(5): 653 - 658. [Abstract] [Full Text] [PDF]

				R. B. Abraham, N. Marouani, and A. A. Weinbroum Dextromethorphan Mitigates Phantom Pain in Cancer Amputees Ann. Surg. Oncol., April 1, 2003; 10(3): 268 - 274. [Abstract] [Full Text] [PDF]

				A. A. Weinbroum A Single Small Dose of Postoperative Ketamine Provides Rapid and Sustained Improvement in Morphine Analgesia in the Presence of Morphine-Resistant Pain Anesth. Analg., March 1, 2003; 96(3): 789 - 795. [Abstract] [Full Text] [PDF]

				A. A. Weinbroum Dextromethorphan Reduces Immediate and Late Postoperative Analgesic Requirements and Improves Patients' Subjective Scorings After Epidural Lidocaine and General Anesthesia Anesth. Analg., June 1, 2002; 94(6): 1547 - 1552. [Abstract] [Full Text] [PDF]