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Canadian Journal of Anesthesia 47:585-596 (2000)
© Canadian Anesthesiologists' Society, 2000
Review Article

The role of dextromethorphan in pain control

Avi A. Weinbroum, MD*,{dagger}, Valery Rudick, MD*, Gideon Paret, MD{ddagger} and Ron Ben-Abraham, MD*

* From the Department of Anesthesiology and Critical Care,
{dagger} Post-Anesthesia Care Unit,
{ddagger} Tel-Aviv Sourasky Medical Center, and the Pediatric Intensive Care Unit, Sheba Medical Center, both affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

Address correspondence to: Avi A. Weinbroum MD, 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

Abstract

Objectif : Passer en revue les bénéfices cliniques du dextrométhorphane (DM) et décrire ses propriétés neuropharmacologiques.

Source : Une recherche dans Medline a fourni des données expérimentales et cliniques sur le DM, utilisé de 1967 à aujourd'hui, à l'aide des mots-clés nociception, soulagement de la douleur aiguë et chronique, N-méthyl-D-aspartate, antagonistes, dextrométhorphane.

Constatations principales : Les 930 références trouvées décrivent surtout les aspects antitussifs, métaboliques et toxicologiques du DM, les études sur des animaux et le rôle possible dans la réduction des complications de l'ischémie cérébrale chez l'humain. Huit études originales auprès de 443 patients, deux rapports préliminaires et nos propres données non publiées sur 513 patients concernent le soulagement de la douleur aiguë. La majorité des 956 patients ont eu une anesthésie générale. Huit études (154 patients) et une observation portent sur le traitement de la douleur chronique. Cet antagoniste des récepteurs N-méthyl-D-aspartate (NMDA) se fixe sur les sites récepteurs dans la moelle épinière et le système nerveux central. Il empêche ainsi la propagation centrale des sensations de douleurs aiguës et chroniques provenant de stimuli nociceptifs périphériques, et contribue à la réduction de la quantité d'analgésiques nécessaires au traitement. Des doses de 30-90 mg de DM atténuent la sensation de douleur aiguë, sans produire d'effets secondaires importants, et permettent de réduire la quantité d'analgésiques chez 73 % des patients traités avec du DM après une intervention chirurgicale. Les études de modèles de douleurs secondaires chez des volontaires sains et de différents types de douleurs chroniques, ont révélé que le DM n'apporte pas de soulagement de la douleur satisfaisant.

Conclusion : Le DM atténue la sensation de douleur aiguë et présente des effets secondaires acceptables. Son conditionnement sous forme orale lui confère des avantages sur d'autres antagonistes de NMDA.




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This Article
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