Dextromethorphan and dexmedetomidine: new agents for the control of perioperative pain.
Most traditional opioids and non-steroidal anti-inflammatory drugs that are used to control perioperative pain have substantial side effects. The number of choices in clinical use was recently increased by two promising groups of drugs: N-methyl-D-aspartate receptor antagonists and central alpha2 agonists. One N-methyl-D-aspartate antagonist, dextromethorphan, blocks the generation of central pain sensation that arise from peripheral nociceptive stimuli by moderating the activity of N-methyl-D-aspartate. It pre-empts the sensation of acute pain at doses of 30-90 mg without serious side effects, while reducing the amount of analgesics required perioperatively by 50%. It is available in oral form and has a confirmed lack of effect on haemodynamics and respiration. Dexmedetomidine is a relatively new, highly selective central alpha2 agonist. Its sedative, pro-anaesthetic and pro-analgesic effects at 0.5-2 microg/kg given intravenously stem mainly from its ability to blunt the central sympathetic response by as yet unknown mechanism(s) of action. It also minimises opioid-induced muscle rigidity, lessens postoperative shivering, causes minimal respiratory depression, and has haemodynamic stabilising effects.
Weinbroum
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Post Anaesthesia Care Unit, Tel Aviv Sourasky Medical Centre affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel. draviw@tasmc.health.gov.il
Ben-Abraham
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D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use*; D000700:Analgesics / Q000627:therapeutic use*; D000818:Animals; D020927:Dexmedetomidine / Q000627:therapeutic use*; D003915:Dextromethorphan / Q000627:therapeutic use*; D006801:Humans; D016202:N-Methylaspartate / Q000037:antagonists & inhibitors*; D010146:Pain / Q000503:physiopathology; D010149:Postoperative Pain / Q000517:prevention & control*; D011292:Premedication; D018341:Receptors, Adrenergic, alpha-2 / Q000502:physiology; D016194:Receptors, N-Methyl-D-Aspartate / Q000502:physiology
D000316:Adrenergic alpha-Agonists; D000700:Analgesics; D018341:Receptors, Adrenergic, alpha-2; D016194:Receptors, N-Methyl-D-Aspartate; D016202:N-Methylaspartate; D020927:Dexmedetomidine; D003915:Dextromethorphan