The Effect of the Preemptive Use of the NMDA Receptor Antagonist Dextromethorphan on Postoperative Analgesic Requirements

Helmy, S. A. K.; Bali, Ayham

doi:10.1213/00000539-200103000-00035

Cited by 61 publications

(11 citation statements)

References 29 publications

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“…In another study, pre-emptive dosing with dextromethorphan reduced postoperative analgesic requirements [26•]. Other studies also support the theory that preoperative treatment with dextromethorphan improves postoperative pain control [27,28].…”

Section: The Potential Of N-methyl-d-aspartateenhanced Opioid Analgesiamentioning

confidence: 85%

N-methyl-D-aspartateenhanced analgesia

Hewitt¹

2003

Current Science Inc

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A greater understanding of the mechanisms that produce chronic pain states has led to a search for novel agents with the potential to produce analgesia by directly modulating specific processes involved in the transduction, transmission, modulation, perception, and encoding of pain. It is hoped that compounds directed at these specific targets will produce better analgesics with an improved side-effect profile. The N-methyl-D-aspartate receptor has been shown to play an important role in pain modulation and has become a target for potential analgesic compounds. Antagonists to the N-methyl-D-aspartate receptor were antinociceptive in a number of animal models, and analgesic in experimental pain models in healthy subjects and in chronic neuropathic pain syndromes. In addition, these compounds have demonstrated the ability to prevent the development of tolerance to opioid analgesic therapy. This has led to investigations of therapies that combine an opioid agonist with an N-methyl-D-aspartate receptor antagonist.

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Section: The Potential Of N-methyl-d-aspartateenhanced Opioid Analgesiamentioning

confidence: 85%

N-methyl-D-aspartateenhanced analgesia

Hewitt¹

2003

Current Science Inc

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“…The most prevalent methods include administration of: NSAIDs 25 , which prevent peripheral sensitization by reducing prostaglandin synthesis at the site of surgery; regional anaesthetics 7 , which block afferent nociceptive impulses prior to incision; opioids 19,27 , which modulate afferent input by blocking the postsynaptic receptors and decreasing neurotransmitter release or by activating inhibitory pathways; and NMDA-receptor antagonists 11 , which inhibit activation of N-methyl-Daspartate (NMDA) receptors in the human spinal cord, thus preventing the main mechanism of central sensitization. Other strategies include alpha 2 receptor antagonists and cholecystokinin 16 .…”

Section: Discussionmentioning

confidence: 99%

Preemptive effect of ketoprofen on postoperative pain following third molar surgery. A prospective, randomized, double-blinded clinical trial

Kaczmarzyk

Wichlinski

Stypulkowska

et al. 2010

International Journal of Oral and Maxillofacial Surgery

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“…The interaction between DM and local anesthetics is yet to be clearly defined. However, the anecdotal clinical evidence does point toward existence of such an effect (15,17). DM has a role in preventing central sensitization by antagonizing NMDARs (5-7).…”

Section: Discussionmentioning

confidence: 99%

Preincisional Dextromethorphan Combined with Thoracic Epidural Anesthesia and Analgesia Improves Postoperative Pain and Bowel Function in Patients Undergoing Colonic Surgery

Yeh¹,

Jao²,

Huh³

et al. 2005

Anesthesia & Analgesia

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Colonic surgery is associated with severe postoperative pain and postoperative ileus, which contribute to delayed hospital discharge. In previous studies, we demonstrated that IM dextromethorphan (DM) provided preemptive analgesia and improved postoperative pain. The benefit of thoracic epidural anesthesia (TEA) and postoperative epidural analgesia on postoperative pain was well demonstrated. The goal of this study was to investigate the effect of preincisional IM DM combined with intraoperative TEA and postoperative patient-controlled epidural analgesia (PCEA) on pain and bowel function after colonic surgery. Patients were randomized into 3 equal groups to receive: 1) chlorpheniramine maleate (CPM) 20 mg and general anesthesia (CPM-GA); 2) CPM 20 mg and GA combined with TEA (CPM-TEA); or 3) DM 40 mg (containing 20 mg of CPM) and GA combined with TEA (DM-TEA). The CPM, DM, and TEA with lidocaine were administered after GA induction via an IM injection and 30 min before the skin incision. All patients received postoperative PCEA for pain control. Analgesic effects were evaluated for 72 h after surgery using visual analog scale pain scores at rest and moving, time to first PCEA request for pain relief, total PCEA consumption, and the time to first passage of flatus. Statistically significant improvement of postoperative pain and bowel function was observed in the following order: DM-TEA > CPM-TEA > CPM-GA. Compared with the CPM-TEA group, the DM-TEA group averaged 1.6 points lower on first-hour pain scores, 40 min longer to first PCEA request, 15.8 mL less PCEA drug over 72 h, and 14.7 h earlier bowel function (all P < 0.01). We conclude that the combination of preincisional DM (40 mg IM), intraoperative TEA, and postoperative PCEA enhances analgesia and facilitates recovery of bowel function, suggesting possible synergistic interaction with local anesthetics and opioids.

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The Effect of the Preemptive Use of the NMDA Receptor Antagonist Dextromethorphan on Postoperative Analgesic Requirements

Cited by 61 publications

References 29 publications

N-methyl-D-aspartateenhanced analgesia

N-methyl-D-aspartateenhanced analgesia

Preemptive effect of ketoprofen on postoperative pain following third molar surgery. A prospective, randomized, double-blinded clinical trial

Preincisional Dextromethorphan Combined with Thoracic Epidural Anesthesia and Analgesia Improves Postoperative Pain and Bowel Function in Patients Undergoing Colonic Surgery

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