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REGIONAL ANESTHESIA AND PAIN MANAGEMENT

Preincisional Dextromethorphan Treatment Decreases Postoperative Pain and Opioid Requirement After Laparoscopic Cholecystectomy

Ching-Tang Wu, MD^*, Jyh-Cherng Yu, MD, Chun-Chang Yeh, MD^*, Sy-Tzu Liu, MD^*, Chi-Yuan Li, MD^*, Shung-Tai Ho, MD^*, and Chih-Shung Wong, MD, PhD^*

Departments of *Anesthesiology and Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan

Address correspondence and reprint requests to Dr. Chih-Shung Wong, Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, #8, Section 3, Tingchow Rd., Taipei, Taiwan 100, Republic of China.

In the present study, we examined whether preincisional treatment with dextromethorphan (DM) provides preemptive analgesia. Ninety patients scheduled for laparoscopic cholecystectomy were included. Patients receiving chlorpheniramine maleate (CPM) 20 mg via an IM injection 30 min before skin incision were designated as the control group. Patients in Group A received DM 40 mg (containing CPM 20 mg) IM after removal of the gallbladder, whereas in Group B, DM 40 mg (containing CPM 20 mg) was administered IM 30 min before skin incision. Meperidine (1 mg/kg IM) was given for postoperative pain relief as required. Times to first meperidine injection, total meperidine consumption, worst pain score, bed rest time, and side effects were recorded for 48 h after surgery. Times to first meperidine injection were 9.3 ± 15.9, 17.4 ± 3.4, and 28.6 ± 3.9 h for the control group and Groups A and B, respectively. The total meperidine consumption was 90.7 ± 11.9, 77.5 ± 12.7, and 20.0 ± 4.4 mg for the control group and Groups A and B, respectively. The worst visual analog pain scores were 6.0 ± 0.2, 6.0 ± 0.2, and 4.0 ± 0.4 for the control group and Groups A and B, respectively. The bed rest times were 21.0 ± 0.5, 20.0 ± 0.5, and 19.0 ± 0.4 h for the control group and Groups A and B, respectively. The number of patients who required meperidine injection was 26, 22, and 12 for the control group and Groups A and B, respectively. We conclude that DM is more effective in producing postoperative analgesia when it is administered preincision rather than after the gallbladder removal treatment, which suggests a preemptive analgesic effect.

Implications: Preincisional dextromethorphan (40 mg IM) treatment offers a preemptive analgesic effect, thus improving the postoperative pain management.

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