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Titolo:
Effect of preoperative oral dextromethorphan on immediate and late postoperative pain and hyperalgesia after total abdominal hysterectomy
Autore:
Ilkjaer, S; Bach, LF; Nielsen, PA; Wernberg, M; Dahl, JB;
Indirizzi:
Herlev Univ Hosp, Dept Anaesthesiol, DK-2730 Herlev, Denmark Herlev Univ Hosp Herlev Denmark DK-2730 thesiol, DK-2730 Herlev, Denmark Aarhus Univ, Skejby Hosp, Dept Anaesthesiol, DK-8200 Aarhus, Denmark Aarhus Univ Aarhus Denmark DK-8200 Anaesthesiol, DK-8200 Aarhus, Denmark
Titolo Testata:
PAIN
fascicolo: 1-2, volume: 86, anno: 2000,
pagine: 19 - 24
SICI:
0304-3959(200005)86:1-2<19:EOPODO>2.0.ZU;2-2
Fonte:
ISI
Lingua:
ENG
Soggetto:
RECEPTOR ANTAGONIST DEXTROMETHORPHAN; TEMPORAL SUMMATION; DORSAL HORN; 2ND PAIN; MORPHINE; RAT; KETAMINE; MK-801; EFFICACY;
Keywords:
dextromethorphan; NMDA antagonist; postoperative pain; hyperalgesia; analgesia;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
29
Recensione:
Indirizzi per estratti:
Indirizzo: Dahl, JB Herlev Univ Hosp, Dept Anaesthesiol, DK-2730 Herlev, Denmark Herlev Univ Hosp Herlev Denmark DK-2730 DK-2730 Herlev, Denmark
Citazione:
S. Ilkjaer et al., "Effect of preoperative oral dextromethorphan on immediate and late postoperative pain and hyperalgesia after total abdominal hysterectomy", PAIN, 86(1-2), 2000, pp. 19-24

Abstract

Dextromethorphan is a noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist known to inhibit wind-up and NMDA-mediated nociceptive responsesof dorsal horn neurons. Experimental and clinical studies indicate that NMDA-receptor antagonists may potentiate the effect of analgesics such as morphine, local anesthetics and NSAIDs. Results from previous clinical studiesof dextromethorphan in postoperative pain are conflicting, possibly related to administration of insufficient doses of the drug. Fifty patients scheduled for non-malignant elective abdominal hysterectomy in general anesthesia were randomized to receive oral dextromethorphan 150 mg, or placebo 1 h before surgery. The patients received patient-controlled analgesia with morphine for 24 h postoperatively as the only analgesic. Patient-controlled analgesia (PCA) morphine consumption was reduced with 30% from 0-4 h after operation in patients receiving dextromethorphan compared with placebo (P = 0.02); no differences were observed from 5-24 h postoperatively. There were no significant differences between groups for visual analogue scale scores at rest, during cough, or during mobilization, pressure pain detection thresholds, von Frey hair pain detection thresholds, or peak flow. At 24 h afteroperation, hyperalgesia to von Frey hair stimulation proximal to the surgical wound was easily detected in 23 of 25 patients receiving dextromethorphan, and in 22 of 25 patients receiving placebo, with no significant difference between,groups. Pooled data from both,groups showed a weak but significant correlation between the extent of hyperalgesia at 24 h after operation,and total 24 h postoperative PCA morphine consumption (Rs = 0.28, P = 0.05). Three months postoperatively, hyperalgesia was still detectable in 18 of22 examined patients in the dextromethorphan group, and in 16 of 23 patients in the placebo group, without statistical differences between groups. There were no significant differences in side-effects (nausea, vomiting, sedation). In conclusion, oral dextromethorphan 150 mg reduced PCA morphine consumption immediately (0-4 h) after hysterectomy, without prolonged effects on pain or wound hyperalgesia. A positive correlation between the magnitudeof wound hyperalgesia at 24 h after operation, and total 24 h postoperative PCA morphine consumption was demonstrated. (C) 2000 International Association for the Study of Pain. Published by Elsevier Science B.V. All rights reserved.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 22/01/20 alle ore 06:58:45