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Titre du document / Document title

The effect of the preemptive use of the NMDA receptor antagonist dextromethorphan on postoperative analgesic requirements

Auteur(s) / Author(s)

HELMY Sanaa A. K. (1) ; BALI Ayham (1) ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

(1) Anesthesia Department, Faculty of Medicine, Cairo University, Cairo, EGYPTE

Résumé / Abstract

Both central sensitization after peripheral tissue injury and the development of opiate tolerance involve activation of N-methyl-D-aspartate receptors. In this double-blinded, randomized study, we investigated the preemptive versus postincisional effects of dextromethorphan, an N-methyl-D-aspartate receptor antagonist, on postoperative pain management. Sixty ASA I and II patients undergoing elective upper abdominal surgery were randomly allocated to three equally sized groups. The Preincisional group patients received dextromethorphan (120 mg) IM 30 min before skin incision and a placebo (isotonic saline) 30 min before the end of surgery. The Postincisional group received the same dose of dextromethorphan 30 min before the end of surgery and a placebo 30 min before skin incision, and the Control group received a placebo both 30 min before skin incision and 30 min before the end of surgery. A standard general anesthetic technique including fentanyl, propofol, isoflurane, and atracurium was used. Postoperative meperidine patient-controlled analgesia (PCA) was used. There were no significant group differences in the median pain scores except in the visual analog scale at 6 h both at rest and on movement; these were significantly lower in the Preincisional group than the other two groups (P < 0.05). The mean time to initiation of PCA was significantly longer in the Preincisional than in the Postincisional and Control groups (mean [SD]: 10.7 [2.2 h], 5.4 [2.1 h], and 3.7 [1.6 h], respectively; P < 0.001]. The 24-h PCA-meperidine consumption was significantly less in the Preincisional than in the Postincisional and Control groups (mean [SD]: 140 [60 mg], 390 [80 mg], and 570 [70 mg], respectively; P < 0.001]. The incidence of postoperative hypoxemia (Spo2 < 90%) and nausea was significantly less in the Preincisional group (P < 0.05). In conclusion, preincisional IM 120 mg dextromethorphan compared with the same postincisional dose significantly reduced postoperative meperidine consumption.

Revue / Journal Title

Anesthesia and analgesia    ISSN  0003-2999   CODEN AACRAT 

Source / Source

2001, vol. 92, no3, pp. 739-744 (26 ref.)

Langue / Language

Anglais

Editeur / Publisher

Lippincott Williams & Wilkins, Hagerstown, MD, ETATS-UNIS  (1957) (Revue)

Mots-clés anglais / English Keywords

Dextromethorphan

;

Antagonist

;

NMDA receptor

;

Analgesic

;

Surgery

;

Pain

;

Postoperative

;

Chemotherapy

;

Prevention

;

Human

;

Analgesia

;

Intramuscular administration

;

Morphinan derivatives

;

Opiates

;

Glutamate receptor

;

Mots-clés français / French Keywords

Dextrométhorphane

;

Antagoniste

;

Récepteur NMDA

;

Analgésique

;

Chirurgie

;

Douleur

;

Postopératoire

;

Chimiothérapie

;

Prévention

;

Homme

;

Analgésie

;

Voie intramusculaire

;

Morphinane dérivé

;

Opiacés

;

Récepteur glutamate

;

Mots-clés espagnols / Spanish Keywords

Dextrometorfano

;

Antagonista

;

Receptor NMDA

;

Analgésico

;

Cirugía

;

Dolor

;

Postoperatorio

;

Quimioterapia

;

Prevención

;

Hombre

;

Analgesia

;

Vía intramuscular

;

Morphinano derivado

;

Opiados

;

Receptor glutámato

;

Localisation / Location

INIST-CNRS, Cote INIST : 3213, 35400009867996.0340

Nº notice refdoc (ud4) : 914417



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