Improved Postoperative Pain Control in Pediatric Adenotonsillectomy With Dextromethorphan

Dawson, Glen; Seidman, Peggy A.; Ramadan, Hassan H.

doi:10.1097/00005537-200107000-00015

Cited by 23 publications

(32 citation statements)

References 30 publications

(41 reference statements)

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“…The end effect is decreased central release of glutamate, an excitatory amino acid that heightens pain perception after peripheral inflammatory stimuli. Dextromethorphan also has a cytoprotective effect proven to decrease neuronal damage and secondary hyperalgesia in animal models 9 . It lacks activity at the opioid μ receptor; therefore, undesirable central nervous system depressant qualities and addictive potential are not seen 12 .…”

Section: Discussionmentioning

confidence: 99%

“…Dextromethorphan also has a cytoprotective effect proven to decrease neuronal damage and secondary hyperalgesia in animal models. 9 It lacks activity at the opioid receptor; therefore, undesirable central nervous system depressant qualities and addictive potential are not seen. 12 The predominant adverse effect was central nervous system stimulation most commonly seen at the upper end of the dosage scale (Ͼ10 mg/kg).…”

Section: Discussionmentioning

confidence: 99%

“…Tramadol is devoid of action on platelets and it is believed not to induce respiratory depression in the clinically used dose range 8 . Recently published studies regarding perioperative use of dextromethorphan, a d‐isomer of the codeine analogue levorphanol, and its use in postoperative analgesic effects have yielded conflicting results 9 . This agent is commonly available in the form of over‐the‐counter cough syrups and is recognized as safe for use in children and adults.…”

Section: Introductionmentioning

confidence: 99%

“…8 Recently published studies regarding perioperative use of dextromethorphan, a d-isomer of the codeine analogue levorphanol, and its use in postoperative analgesic effects have yielded conflicting results. 9 This agent is commonly available in the form of over-the-counter cough syrups and is recognized as safe for use in children and adults. Its mechanism of analgesia is through N-methyl-D-aspartic acid antagonism and subsequent inhibition of glutamate, an excitatory amino acid neurotransmitter in the spinal cord.…”

Section: Introductionmentioning

confidence: 99%

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Tramadol for Pain Relief in Children Undergoing Adenotonsillectomy: A Comparison with Dextromethorphan

2008

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Objective/Hypothesis: Establishment of good analgesia is of major concern in the postoperative period after adenotonsillectomy. The aim of this study was to compare the effects of dextromethorphan and tramadol on postoperative pain after adenotonsillectomy in children. Study Design: Randomized study. Methods: Ninety ASA class I, II (children age, 4–10 years) scheduled for adenotonsillectomy were randomized into three groups to receive placebo syrup (control group), 1 mg/kg dose of dextromethorphan cough syrup oral (Dex group) or oral placebo syrup (Tramadol group), 30 minutes before arrival in the operating room. Then during induction of anesthesia group control received 0.9% physiological saline, group Dex received 0.9% physiological saline, group Tramadol (1 mg/kg) of tramadol hyrochloride intravenously, in a total volume of 4 mL. Postoperative analgesic requirements and side effects were recorded. Pain was assessed by face scale every hour up to 6 hours postop. Results: There were no statistically significant differences in age, weight, and sex between groups (P > .05). There were statistically significant differences in, pain scores in first time postoperatively and further analgesic requirements (P < .05). All patients in placebo group (100%), two patients in the tramadol group (6.6%), and nine patients in dextromethorphan group (40%) required supplementary meperidine in recovery room. The incidence of nausea and vomiting was 5.5% in the Dextrometorphan group, 10% in the tramadol group, 6.6% in the control group; there was no significant difference between the groups (P > .05). Conclusions: Intravenous tramadol (1 mg/kg) is more suitable than 1 mg/kg dose of dextromethorphancough syrup oral in reducing posttonsillectomy pain in children.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Tramadol for Pain Relief in Children Undergoing Adenotonsillectomy: A Comparison with Dextromethorphan

2008

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“…The efficacy of the preoperative use of dextromethorphan for control of post-adenotonsillectomy pain is controversial. Dawson and colleagues reported a 34% reduction in the need for intravenous (IV) morphine during the first 6 hours after surgery in children who received a single 1 mg/kg dose of dextromethorphan preoperatively 24. However; there was no difference in oral analgesic consumption or type of diet tolerated from controls beyond 6 hours.…”

Section: Pharmacological Interventionsmentioning

confidence: 99%

Acute pain management in children

Verghese

Hannallah²

2010

JPR

172

132

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The greatest advance in pediatric pain medicine is the recognition that untreated pain is a significant cause of morbidity and even mortality after surgical trauma. Accurate assessment of pain in different age groups and the effective treatment of postoperative pain is constantly being refined; with newer drugs being used alone or in combination with other drugs continues to be explored. Several advances in developmental neurobiology and pharmacology, knowledge of new analgesics and newer applications of old analgesics in the last two decades have helped the pediatric anesthesiologist in managing pain in children more efficiently. The latter include administering opioids via the skin and nasal mucosa and their addition into the neuraxial local anesthetics. Systemic opioids, nonsteroidal anti-inflammatory agents and regional analgesics alone or combined with additives are currently used to provide effective postoperative analgesia. These modalities are best utilized when combined as a multimodal approach to treat acute pain in the perioperative setting. The development of receptor specific drugs that can produce pain relief without the untoward side effects of respiratory depression will hasten the recovery and discharge of children after surgery. This review focuses on the overview of acute pain management in children, with an emphasis on pharmacological and regional anesthesia in achieving this goal.

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Guidelines for Opioid Prescribing in Children and Adolescents After Surgery

et al. 2021

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IMPORTANCEOpioids are frequently prescribed to children and adolescents after surgery. Prescription opioid misuse is associated with high-risk behavior in youth. Evidence-based guidelines for opioid prescribing practices in children are lacking.OBJECTIVE To assemble a multidisciplinary team of health care experts and leaders in opioid stewardship, review current literature regarding opioid use and risks unique to pediatric populations, and develop a broad framework for evidence-based opioid prescribing guidelines for children who require surgery.EVIDENCE REVIEW Reviews of relevant literature were performed including all English-language articles published from January 1, 1988, to February 28, 2019, found via searches of the PubMed (MEDLINE), CINAHL, Embase, and Cochrane databases. Pediatric was defined as children younger than 18 years. Animal and experimental studies, case reports, review articles, and editorials were excluded. Selected articles were graded using tools from the Oxford Centre for Evidence-based Medicine 2011 levels of evidence. The Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument was applied throughout guideline creation. Consensus was determined using a modified Delphi technique.FINDINGS Overall, 14 574 articles were screened for inclusion, with 217 unique articles included for qualitative synthesis. Twenty guideline statements were generated from a 2-day in-person meeting and subsequently reviewed, edited, and endorsed externally by pediatric surgical specialists, the American Pediatric Surgery Association Board of Governors, the American Academy of Pediatrics Section on Surgery Executive Committee, and the American College of Surgeons Board of Regents. Review of the literature and guideline statements underscored 3 primary themes: (1) health care professionals caring for children who require surgery must recognize the risks of opioid misuse associated with prescription opioids, (2) nonopioid analgesic use should be optimized in the perioperative period, and (3) patient and family education regarding perioperative pain management and safe opioid use practices must occur both before and after surgery.CONCLUSIONS AND RELEVANCE These are the first opioid-prescribing guidelines to address the unique needs of children who require surgery. Health care professionals caring for children and adolescents in the perioperative period should optimize pain management and minimize risks associated with opioid use by engaging patients and families in opioid stewardship efforts.

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Improved Postoperative Pain Control in Pediatric Adenotonsillectomy With Dextromethorphan

Abstract: Dextromethorphan syrup is a safe, non-narcotic medication that significantly reduced the requirement of intravenous morphine after pediatric adenotonsillectomy. Its routine use in this manner is recommended.

Cited by 23 publications

References 30 publications

Tramadol for Pain Relief in Children Undergoing Adenotonsillectomy: A Comparison with Dextromethorphan

Tramadol for Pain Relief in Children Undergoing Adenotonsillectomy: A Comparison with Dextromethorphan

Acute pain management in children

Guidelines for Opioid Prescribing in Children and Adolescents After Surgery

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