Role of N-methyl-D-aspartate receptor antagonists in postoperative pain management.
OBJECTIVE
In recent years, hundreds of studies have examined the clinical efficacy of N-methyl-D-aspartate (NMDA) receptor antagonists such as ketamine and dextromethorphan as an adjunct to routine postoperative pain management. The purpose of this review is to describe the detail of the study that successfully demonstrated the efficacy of NMDA receptor antagonists.


RESULTS
The effect of perioperative ketamine infusion, dextromethorphan, and memantine on postoperative opioid-induced analgesia and prevention of long-term persistent pain is described.


CONCLUSIONS
The co-administration of ketamine and morphine as a mixture is not recommended for postoperative pain relief. As an adjunct in multimodal analgesia, low-dose ketamine infusion and the administration of dextromethorphan may be able to improve postoperative pain status. Memantine exhibits the greatest potency among NMDA receptor antagonists. In future, research should consider the perioperative infusion of ketamine followed by long-term administration of memantine for the prevention of persistent pain.
Suzuki
Manzo
M
Department of Anesthesiology, Musashikosugi Hospital Nippon Medical School, Kanagawa, Japan. manzo@nms.ac.jp
D000701:Analgesics, Opioid / Q000008:administration & dosage; D003915:Dextromethorphan / Q000008:administration & dosage; D004338:Drug Combinations; D004359:Drug Therapy, Combination / Q000379:methods; D018691:Excitatory Amino Acid Antagonists / Q000008:administration & dosage*; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D007649:Ketamine / Q000008:administration & dosage*; D008559:Memantine / Q000008:administration & dosage*; D010149:Postoperative Pain / Q000517:prevention & control*; D016194:Receptors, N-Methyl-D-Aspartate / Q000037:antagonists & inhibitors*
D000701:Analgesics, Opioid; D004338:Drug Combinations; D018691:Excitatory Amino Acid Antagonists; D016194:Receptors, N-Methyl-D-Aspartate; D007649:Ketamine; D003915:Dextromethorphan; D005283:Fentanyl; D008559:Memantine