title: Effect of N-Methyl-D-Aspartate Receptor Antagonist Dextromethorphan on Opioid Analgesia in Pediatric Intensive Care Unit.
abstract: Objective. Pain control is an essential goal in the management of critical children. Narcotics are the mainstay for pain control. Patients frequently need escalating doses of narcotics. In such cases an adjunctive therapy may be beneficial. Dextromethorphan (DM) is NMDA receptor antagonist and may prevent tolerance to narcotics; however, its definitive role is still unclear. We sought whether dextromethorphan addition could decrease the requirements of fentanyl to control pain in critical children.Design. Double-blind, randomized control trial (RCT).Setting. Pediatric multidisciplinary ICU in tertiary care center.Patients. Thirty-six pediatric patients 2-14 years of age in a multidisciplinary PICU requiring analgesia were randomized into dextromethorphan and placebo. The subjects in both groups showed similarity in most of the characteristics.Interventions. Subjects while receiving fentanyl for pain control received dextromethorphan or placebo through nasogastric/orogastric tubes for 96 hours. Pain was assessed using FLACC and faces scales.Measurements and Main Results. This study found no statistical significant difference in fentanyl requirements between subjects receiving dextromethorphan and those receiving placebo (p= 0.127).Conclusions. Dextromethorphan has no effect on opioid requirement for control of acute pain in children admitted with acute critical care illness in PICU. The registration number for this trial is NCT01553435.
authors.affiliation: Department of Pediatrics, Division PICU, King Abdulaziz Medical City, Riyadh, Saudi Arabia; King Saud Bin Abdulaziz University-Health Sciences (KSAU-HS), Riyadh, Saudi Arabia; King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia.
authors.forename: Mohammed
authors.identifier: 0000-0003-0544-6557
authors.initials: M
authors.lastname: Naeem
authors.affiliation: Department of Pediatrics, Division PICU, King Abdulaziz Medical City, Riyadh, Saudi Arabia; King Saud Bin Abdulaziz University-Health Sciences (KSAU-HS), Riyadh, Saudi Arabia; King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia.
authors.forename: Hala
authors.initials: H
authors.lastname: Al Alem
authors.affiliation: Department of Pediatrics, Division PICU, King Abdulaziz Medical City, Riyadh, Saudi Arabia; King Saud Bin Abdulaziz University-Health Sciences (KSAU-HS), Riyadh, Saudi Arabia; King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia.
authors.forename: Ali
authors.initials: A
authors.lastname: Al Shehri
authors.affiliation: King Saud Bin Abdulaziz University-Health Sciences (KSAU-HS), Riyadh, Saudi Arabia; King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia; Department of Pharmacy, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
authors.forename: Majed
authors.initials: M
authors.lastname: Al-Jeraisy
mesh_terms: D000293:Adolescent; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003915:Dextromethorphan / Q000627:therapeutic use*; D004311:Double-Blind Method; D018691:Excitatory Amino Acid Antagonists / Q000627:therapeutic use*; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use*; D015600:Glasgow Coma Scale; D006801:Humans; D015278:Intensive Care Units, Pediatric; D008297:Male; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D018691:Excitatory Amino Acid Antagonists; D003915:Dextromethorphan; D005283:Fentanyl