Perioperative Dextromethorphan Reduces Postoperative Pain After Hysterectomy

Henderson, Duncan J.; Withington, Brian S.; Wilson, John A.; Morrison, L. M. M.

doi:10.1097/00000539-199908000-00028

Cited by 25 publications

(40 citation statements)

References 15 publications

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“…NMDA receptor results in decreased neuronal excitability. This is the theoretical basis of the antinociceptive properties seen by dextromethorphan in previous studies (Chia et al, 1999;Henderson et al, 1999). Thus, it is theorized that blocking hypersensitization via the NMDA receptor prevents the enhanced response to painful stimuli.…”

Section: Conceptual Frameworkmentioning

confidence: 83%

“…Some studies have concluded that dextromethorphan decreases postoperative pain with a concomitant reduction in analgesic use (Chia, Liu, Chow, & Lee, 1999;Henderson, et al, 1999;Kawamata, Omote, Kawamata, & Namiki, 1998). Other studies have failed to show any effect on pain levels or amount of analgesics required (Grace et al, 1998;Rose, Cuy, Cohen, & Schreiner, 1999).…”

Section: Statement Of the Problemmentioning

confidence: 99%

“…Build up of an enhanced painful stimulus produces a process known as "wind up" where the threshold for triggering an action potential is lowered. This causes an earlier and more intense discharge when threshold is achieved (Henderson et al, 1999). Intensified potentiation of pain transmission can last from hours to days.…”

Section: Conceptual Frameworkmentioning

confidence: 99%

“…The need for patient satisfaction, minimal pain and discomfort foUovi^ing surgery are desirable outcomes toward which every anesthesia provider should strive (Henderson et al, 1999). Surgical advances are enabling more procedures to be done on an outpatient basis resulting in patients returning home a few hours after surgery.…”

Section: Review Of Related Literaturementioning

confidence: 99%

“…This mechanism is thought to be responsible for lowering the firing threshold leading to central hypersensitivity ("wind-up"), an enhanced response to painful stimuli (Henderson, Withington, Wilson, & Morrison, 1999). Furthermore, dextromethorphan has no sedative or respiratory depressant effects unlike narcotics or other NMDA antagonists (e.g.…”

mentioning

confidence: 99%

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The Effect of Pre-Emptive Administration of Dextromethorphan on Postoperative Pain in Patients Undergoing Interval Laparoscopic Tubal Sterilization

Pitcher¹

2001

PsycEXTRA Dataset

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Public reportino burden for tNs collection of information is estimated to average 1 hour per response, including the time for reviewing inslnictions, searching existing data sources, gathering and maintaining the date needed, and completing and reviewing the collection of information. Send comments regarding tNs burden estimate or any other aspect of tNs collection of information, including suggestions for reducing tNs burden, TITLE AND SUBTITLEThe effect of pre-emptive administration of dextromethorphan on postoperative pain in patients undergoing interval laparoscopic tubal sterilization AUTHOR(S)CPT Brian M. Pitcher PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES)University Each year an estimated one million women elect to have surgical sterilization. This is performed by a laparoscopic procedure which can be severe enough to warrant an unplanned admission. With an increased understanding of the physiological basis of pain, classes of drugs not normally associated with pam reduction are now being investigated based on their ability to mteract with receptors in the pain pathway. Experimental studies have shown that the N-methyl-D-aspartate (NMDA) receptor plays a significant role in neuronal "wind-up", a state of hyperalgesia that can last from hours to days following injury or trauma.. Interfering with the NMDA receptor prior to surgical stimuli, wmd-up is prevented resuUing in decreased pain and analgesic requirements followmg surgery. Dextromethorphan, a readily available nonopioid antimssive in clinical use for more than 40 years, is one such NMDA receptor Anticosti. This prospective, randomized, double blind pilot study compared the effects over time when patients received dextromethorphan versus placebo-emptively. The sample was comprised of 14 subjects undergomg laparoscopic tubal ligation under general endotracheal anesthesia at regional military medical center for the Pacific Basin. Patients were ASA physical category I or II and at least 18 years of age and assigned to one of two groups. Group I received 60 mg of dextromethorphan orally, and Group II received an oral placebo. Postoperative pain was assessed using an 11 point Numeric Rating Scale (NRS) at eight time intervals. Additionally, a follow-up questionnaire and 48-hour postoperative telephone call were used to collect data on the patients' satisfaction of being in the study. The Student's t-test was used to determine homogeneity between the two groups. Following analysis, a statistically significant difference was found in two areas. Patients who received dextromethorphan 60 mg orally before surgery had a significant decrease m postoperative pain (p<0.04). The amount of Roxicet required postoperative was statistically less in the dextromethorphan group (p<0.02). The preoperative use of dextromethorphan may significantly decreased the amount of postoperative pain experienced with a resultant decrease in need for narcotic analgesics. This prospective, randomized, double blind pilot study compared the effects over time when patients received de...

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Section: Conceptual Frameworkmentioning

confidence: 83%

Section: Statement Of the Problemmentioning

confidence: 99%

Section: Conceptual Frameworkmentioning

confidence: 99%

Section: Review Of Related Literaturementioning

confidence: 99%

mentioning

confidence: 99%

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The Effect of Pre-Emptive Administration of Dextromethorphan on Postoperative Pain in Patients Undergoing Interval Laparoscopic Tubal Sterilization

Pitcher¹

2001

PsycEXTRA Dataset

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Single dose oral dihydrocodeine for acute postoperative pain

Moore

Edwards

Derry

et al. 2000

Cochrane Database of Systematic Reviews

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Background This is an updated version of the original Cochrane review published in Issue 2, 2000. Dihydrocodeine is a synthetic opioid analgesic developed in the early 1900s. Its structure and pharmacokinetics are similar to that of codeine and it is used for the treatment of postoperative pain or as an antitussive. It is becoming increasingly important to assess the relative efficacy and harm caused by different treatments. Relative efficacy can be determined when an analgesic is compared with control under similar clinical circumstances. Objectives To quantitatively assess the analgesic efficacy and adverse effects of single-dose dihydrocodeine compared with placebo in randomised trials in moderate to severe postoperative pain. Search methods Published reports were identified from electronic databases (MEDLINE, EMBASE, CENTRAL, the Oxford Pain Relief Database in December 2007, the original search was conducted in October 1999). Additional studies were identified from the reference lists of retrieved reports. Selection criteria Inclusion criteria: full journal publication, clinical trial, random allocation of participants to treatment groups, double blind design, adult participants, baseline pain of moderate to severe intensity, postoperative administration of study drugs, treatment arms which included dihydrocodeine and placebo and either oral or injected (intramuscular or intravenous) administration of study drugs. Data collection and analysis Data collection and analysis: summed pain intensity and pain relief data over four to six hours were extracted and converted into dichotomous information to yield the number of participants obtaining at least 50% pain relief. This was used to calculate relative benefit and number-needed-to-treat-to-benefit (NNT) for one participant to obtain at least 50% pain relief. Single-dose adverse effect data were collected and used to calculate relative risk and number-needed-to-treat-to-harm (NNH). Main results Fifty-two reports were identified in the original review as possible randomised trials which assessed dihydrocodeine in postoperative pain. Four reports met the inclusion criteria; all assessed oral dihydrocodeine. Three reports (194 participants) compared dihydrocodeine with placebo and one (120 participants) compared dihydrocodeine (30 mg or 60 mg) with ibuprofen 400 mg. For a single dose of dihydrocodeine 30 mg in moderate to severe postoperative pain the NNT for at least 50% pain relief was 8.1 (95% confidence interval 4.1 to 540) when compared with placebo over a period of four to six hours. Pooled data showed significantly more participants to have reported adverse effects with dihydrocodeine 30 mg than with placebo. When compared to ibuprofen 400 mg both dihydrocodeine 30 mg and 60 mg were significantly inferior. No additional studies were found for this update. Authors’ conclusions A single 30 mg dose of dihydrocodeine is not sufficient to provide adequate pain relief in postoperative pain. Statistical superiority of ibuprofen 400 mg over dihydrocodein...

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The Significance of Chirality in Pharmacological and Toxicological Properties of Drugs

Spasov¹,

Iezhitsa²,

Vassiliev³

et al. 2022

Progress in Drug Research

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Perioperative Dextromethorphan Reduces Postoperative Pain After Hysterectomy

Abstract: Patients given dextromethorphan before and after surgery had a significant reduction in some pain scores at rest, but not on movement. There was a trend to lower morphine requirements in the first 24 h. Over the next 48 h, oral analgesic usage was significantly reduced.

Cited by 25 publications

References 15 publications

The Effect of Pre-Emptive Administration of Dextromethorphan on Postoperative Pain in Patients Undergoing Interval Laparoscopic Tubal Sterilization

The Effect of Pre-Emptive Administration of Dextromethorphan on Postoperative Pain in Patients Undergoing Interval Laparoscopic Tubal Sterilization

Single dose oral dihydrocodeine for acute postoperative pain

The Significance of Chirality in Pharmacological and Toxicological Properties of Drugs

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