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REGIONAL ANESTHESIA AND PAIN MANAGEMENT

The Preoperative Administration of Intravenous Dextromethorphan Reduces Postoperative Morphine Consumption

Yuan-Yi Chia, MD^*, Kang Liu, MD^*, Lok-Hi Chow, MD^,, and Tak-Yu Lee, MD

*Department of Anesthesia, Veterans General Hospital-Kaohsiung, Taipei; Department of Anesthesiology, School of Medicine, National Yang-Ming University, Taipei; and Graduate Institute of Medical Science, National Defense Medical Center, Taipei, Taiwan, Republic of China

Address correspondence and reprint requests to Yuan-Yi Chia, MD, Department of Anesthesiology, Veterans General Hospital-Kaohsiung, 386, Ta-Chung 1st Rd., Kaohsiung, Taiwan, ROC. Address e-mail to yychia{at}isca.vghks.gov.tw

We evaluated the effect of dextromethorphan on postoperative pain management. Sixty ASA physical status I–III female patients undergoing major abdominal surgery underwent standardized general anesthesia. Thirty patients received an IV infusion of dextromethorphan 5 mg/kg before anesthetic induction (Pre group), whereas the remaining 30 patients received the same volume of isotonic sodium chloride solution, followed by a postoperative IV infusion of dextromethorphan 5 mg/kg (Post group). Patients in the Pre group received the same volume of isotonic sodium chloride solution postoperatively. All patients were then treated with patient-controlled IV analgesia, which administered a 0.6-mg bolus of morphine on demand (maximal 4 h dose 20 mg). The mean visual analog pain score during cough or movement and at rest were similar in the two groups in the first 3 days postoperatively. However, Post group patients consumed more morphine than Pre group patients during the first 2 days (P < 0.01). The sedation scores, patient satisfaction, and the incidence of morphine-related side effects were similar between the two groups. We conclude that the preoperative administration of dextromethorphan 5 mg/kg reduces postoperative morphine consumption compared with postoperative administration.

Implications: In this double-blinded study, we found that the preoperative administration of IV dextromethorphan 5 mg/kg, compared with postoperative administration, reduces postoperative morphine consumption, which may provide clinical evidence of preemptive or preventive analgesic effects of dextromethorphan.

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