Dextromethorphan, an N-methyl-D-aspartate (NMDA) receptor antagonist, reduces postoperative pain with less sedation and reduced need for morphine in patients with cancer, according to the results of a randomized, placebo-controlled trial reported in the Sept. 1 issue of Cancer.
“Postoperative pain is mediated centrally by NMDA receptors,” write Avi A. Weinbroum, MD, from the Tel Aviv Sourasky Medical Center in Israel, and colleagues.
“The beneficial effects of preincision oral dextromethorphan, which is an NMDA antagonist, on postoperative pain and intravenous patient-controlled analgesia (IV-PCA) morphine consumption have been examined in patients undergoing surgery.”
In this double-blind trial, 75 patients underwent surgery for bone and soft tissue malignancies, typically associated with more severe postoperative pain than after general surgery. Patients received placebo, dextromethorphan 60 mg, or dextromethorphan 90 mg before surgery and on the first and second postoperative days. All patients received postoperative IV-PCA morphine when visual score for subjective pain intensity was 4/10 or higher and lasted for 72 hours, as well as oral paracetamol or dipyrone as rescue drugs.
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