A qualitative systematic review of peri‐operative dextromethorphan in post‐operative pain

Abstract

Background: The N-methyl-D-aspartate (NMDA) receptor antagonist, dextromethorphan (DM), has received interest as an adjunctive agent in post-operative pain management. Clinical trials have been contradictory. This systematic review aims to evaluate the available literature examining the analgesic efficacy of DM in post-operative patients. Methods: Twenty-eight randomized, double-blind, clinical studies, with 40 comparisons, including a variety of dosing regimens comparing DM treatment with placebo, were included. Meta-analysis was intended but deemed to be inappropriate because of the substantial difference in methodology and reporting between trials. The outcome measures (pain scores at rest, time to first analgesic request and supplemental analgesic consumption) were evaluated qualitatively by significant difference (P < 0.05) as reported in the original investigations. Results: DM did not reduce the post-operative pain score with a clinically significant magnitude. The time to first analgesic request was significantly prolonged in most comparisons with DM. Significant decreases in supplemental opioid consumption were observed in the majority of parenteral DM studies and in

Role of N-methyl-D-aspartate receptor antagonists in postoperative pain management

“…Dextromethorphan has been used for more than 40 years as an antitussive drug. Although the antihyperalgesic effect of dextromethorphan has been reported in volunteers, the results of several clinical trials remain controversial [21].…”

Isobolographic Analysis of Epinephrine With Bupivacaine, Dextromethorphan, 3-Methoxymorphinan, or Dextrorphan on Infiltrative Anesthesia in Rats: Dose-Response Studies

“…4 It has also been used as part of multi-modal analgesic therapy, e.g., for clinical acute pain and neuropathic pain. 5,6 During these applications, DM has been shown to have a wide safety margin with a low rate of untoward side effects. 7 DM is primarily metabolized either by O-demethylation t o dextrorphan (DX) or to a lesser extent by N-demethylation to 3-methoxymorphinan (3MM) in human liver.…”

Multimodal Analgesia for Postoperative Pain Management

“…Following oral administration, it is rapidly absorbed from the gut and crosses the blood-brain barrier. A systematic review of perioperative dextromethorphan treatment for acute post-surgical pain concluded that the drug was a safe potential adjunct to classical opioid-based analgesia, but the results were inconsistent (Duedahl et al, 2006).…”