Related Experiment Videos
Preoperative oral dextromethorphan does not reduce pain or analgesic consumption in children after adenotonsillectomy
1Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and The University of Pennsylvania School of Medicine, 19104, USA. rose@email.chop.edu
Insights
Dextromethorphan premedication did not improve pain relief after adenotonsillectomy in children. The study found no significant differences in pain scores or medication use between groups receiving dextromethorphan or placebo.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Background:
- Postoperative pain management in children undergoing adenotonsillectomy is crucial.
- Dextromethorphan has shown potential analgesic properties.
- Evaluating preemptive analgesia strategies is essential for optimizing pediatric surgical care.
Purpose of the Study:
- To assess the analgesic efficacy of oral dextromethorphan as a premedication for adenotonsillectomy in children.
- To compare pain outcomes and analgesic requirements in children receiving dextromethorphan versus placebo.
Main Methods:
- A randomized, double-blinded, placebo-controlled study involving 57 children aged 6-12 years.
- Children received dextromethorphan (0.5 or 1.0 mg/kg) or placebo orally one hour before surgery.
- Standardized anesthesia, preemptive intravenous morphine, and rectal acetaminophen were administered. Pain was assessed using behavioral scores, CHEOPS, VAS, and parental satisfaction.
Main Results:
- No significant differences were observed in postoperative morphine consumption between the dextromethorphan and placebo groups.
- Behavioral scores, Children's Hospital of Eastern Ontario Pain Scale (CHEOPS), visual analog scale (VAS) pain ratings, and parental satisfaction did not differ significantly across groups.
- Preemptive administration of intravenous morphine and rectal acetaminophen provided comparable analgesia regardless of dextromethorphan premedication.
Conclusions:
- Premedication with oral dextromethorphan does not enhance postoperative analgesia in pediatric adenotonsillectomy patients.
- The combination of preemptive intravenous morphine and rectal acetaminophen appears to provide adequate analgesia, overshadowing any potential benefit of dextromethorphan.
- Further research may be needed to explore alternative analgesic strategies or different patient populations.
Unlabelled:
In this randomized, double-blinded, placebo-controlled, prospective study, we evaluated the analgesic efficacy of dextromethorphan 0.5 mg/kg or 1.0 mg/kg p.o. 1 h before adenotonsillectomy in 57 children 6-12 yr of age. Anesthetic management was standardized. Morphine 0.075 mg/kg i.v. and acetaminophen 25-35 mg/kg p.r. were administered after anesthetic induction but before the start of surgery. A 4-point behavioral score (1 = asleep, 2 = awake and calm, 3 = awake and crying, 4 = thrashing) was recorded on admission to and discharge from the postanesthesia care unit (PACU). In the PACU, pain was assessed with Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) and recorded every 15 min until the patient was transferred to the day surgery unit (DSU). In the DSU, patients rated their pain using a 10-cm baseline 0-10 visual analog pain scale (VAS) every 30 min until they were discharged home. A 24-h VAS was obtained by phone interview, and parental satisfaction was scored (yes/no) regarding their child's postoperative analgesia. Morphine 0.025 mg/kg i.v. was administered to children with CHEOPS score >6, who verbalized pain, or who were crying in any consecutive 5-min observation periods in the PACU. Total morphine consumption was recorded. The study groups were comparable with respect to demographic variables. We were unable to detect any differences between study groups with respect to postoperative morphine consumption, CHEOPS, behavior scores, VAS, or parental satisfaction.
Implications:
Premedication with dextromethorphan 0.5 or 1.0 mg/kg p.o. does not improve postoperative analgesia in school-aged children who receive preemptive morphine 0.075 mg/kg i.v. and acetaminophen 25-35 mg/kg p.r. during nitrous oxide and desflurane anesthesia for adenotonsillectomy.
Related Concept Videos
01:26Tonsillitis II: Management
01:23Upper Respiratory Drugs: Antitussives, Expectorants, and Mucolytics
Antitussives include codeine, dextromethorphan (Robitussin), and benzonatate (Tessalon). Codeine and dextromethorphan exert their effects centrally by suppressing the cough reflex center in the medulla. Benzonatate operates peripherally within the respiratory tract by anesthetizing...
01:24Parenteral Anesthetics: Overview
01:15Opioid Analgesics: Synthetic and Semisynthetic Opioids
01:23Chronic Pharyngitis
Etiology
It often arises from persistent viral or bacterial infections affecting sinuses and tonsils.
Additional contributing factors include inadequate dental hygiene, mouth breathing, recurring tonsillitis, allergic rhinitis, laryngopharyngeal reflux, and exposure to smoke, chemicals, and other environmental pollutants. Allergic reactions to pollen, mold, and pet dander, chronic cough, excessive voice usage,...
01:31Skeletal Muscle Relaxants: Therapeutic Uses