Combined pre-incisional oral dextromethorphan and epidural lidocaine for postoperative pain reduction and morphine sparing: a randomised double-blind study on day-surgery patients.
The reduction in acute pain perception following dextromethorphan has previously been investigated in patients undergoing general anaesthesia. This random and double-blind study examined the effects of pre-incisional oral dextromethorphan on postoperative pain and intravenous patient-controlled morphine demand in 60 day-surgery patients undergoing lower body surgery under lidocaine (1.6%-16 ml) epidural anaesthesia after receiving placebo, 60 or 90 mg dextromethorphan, 90 min pre-operatively. Postoperative pain was scored on a visual analogue scale from 1 to 10. In-hospital observation continued for 6 h and for 3 days at home; diclofenac was available throughout. Dextromethorphan-treated patients reported significantly (p < 0.05) less pain and sedation, and felt better. Patients who received dextromethorphan 90 mg had significantly (p < 0.05) lower heart and respiratory rates than those who received 60 mg. Medicated patients required half the morphine and diclofenac of placebo patients: 38% of patients who received 90 mg and 21% who received dextromethorphan 60 mg used no morphine or diclofenac whatsoever, a previously unreported finding.
Weinbroum
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AA
Department of Anaesthesiology and Critical Care Medicine, Post-Anaesthesia Care Unit, and Pain Clinic, Tel Aviv Sourasky Medical Centre, 6 Weizman Street, Tel Aviv 64239, Israel. graviw@tasmc.health.gov.il
Lalayev
G
G
Yashar
T
T
Ben-Abraham
R
R
Niv
D
D
Flaishon
R
R
D000368:Aged; D000556:Ambulatory Surgical Procedures; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000627:therapeutic use*; D003915:Dextromethorphan / Q000627:therapeutic use*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D018691:Excitatory Amino Acid Antagonists / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008012:Lidocaine / Q000627:therapeutic use*; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D010149:Postoperative Pain / Q000517:prevention & control*; D012119:Respiration / Q000187:drug effects
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D018691:Excitatory Amino Acid Antagonists; D003915:Dextromethorphan; D009020:Morphine; D008012:Lidocaine