A qualitative systematic review of peri-operative dextromethorphan in post-operative pain

• Published in: Acta anaesthesiologica Scandinavica Vol. 50; no. 1; pp. 1 - 13
• Main Authors: Duedahl, T. H., Rømsing, J., Møiniche, S., Dahl, J. B.
• Format: Journal Article
• Language: English
• Published: Oxford, UK; Malden, USA Munksgaard International Publishers 01.01.2006; Blackwell
• Subjects: Analgesics, Opioid - therapeutic use; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; dextromethorphan; Dextromethorphan - therapeutic use; Humans; Medical sciences; N-methyl-d-aspartate (NMDA) receptor antagonists; Pain Measurement; Pain, Postoperative - drug therapy; post-operative pain; Randomized Controlled Trials as Topic; systematic review; Morphinan derivatives; Pain; NMDA; Opiates; Anesthesia; Antitussive agent; Dextromethorphan; N-methyl-D-aspartate (NMDA) receptor antagonists; NMDA receptor; systematic review; post-operative pain
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1111/j.1399-6576.2006.00900.x

Background:  The N‐methyl‐d‐aspartate (NMDA) receptor antagonist, dextromethorphan (DM), has received interest as an adjunctive agent in post‐operative pain management. Clinical trials have been contradictory. This systematic review aims to evaluate the available literature examining the analgesic efficacy of DM in post‐operative patients. Methods:  Twenty‐eight randomized, double‐blind, clinical studies, with 40 comparisons, including a variety of dosing regimens comparing DM treatment with placebo, were included. Meta‐analysis was intended but deemed to be inappropriate because of the substantial difference in methodology and reporting between trials. The outcome measures (pain scores at rest, time to first analgesic request and supplemental analgesic consumption) were evaluated qualitatively by significant difference (P < 0.05) as reported in the original investigations. Results:  DM did not reduce the post‐operative pain score with a clinically significant magnitude. The time to first analgesic request was significantly prolonged in most comparisons with DM. Significant decreases in supplemental opioid consumption were observed in the majority of parenteral DM studies and in about one‐half of the oral studies. The decreases were of questionable clinical importance in most comparisons, although a relationship between a decrease in opioid consumption and opioid‐related side‐effects was established in some studies. Conclusion:  Based on the studies available, DM has the potential to be a safe adjunctive agent to opioid analgesia in post‐operative pain management, but the consistency of the potential opioid‐sparing and pain‐reducing effect must be questioned. Consequently, it is not possible to recommend dose regimens or routine clinical use of DM in post‐operative pain. The route of administration may be important for the beneficial effect.