Dextromethorphan as an Opioid-Sparing Analgesic in Postoperative Pain

Dextromethorphan, traditionally known as a cough suppressant, is emerging as a potent opioid-sparing analgesic in perioperative pain management. This review explores dextromethorphan's multifaceted role in reducing postoperative pain and minimizing opioid consumption, thus optimizing patient recovery and mitigating adverse effects associated with conventional analgesics. Dextromethorphan operates through diverse mechanisms, including N -methyl- d -aspartate receptor antagonism, sigma-1 receptor agonism, and the inhibition of serotonin and norepinephrine reuptake, offering a broad therapeutic window across various types of pain, notably perioperative and neuropathic pain. Clinical trials highlight dextromethorphan's efficacy in lowering pain scores and reducing postoperative opioid requirements, aligning with multimodal analgesia principles, and enhancing patient outcomes. For instance, studies have demonstrated significant reductions in pain and opioid use postsurgery, without compromising safety or recovery milestones. However, dextromethorphan's effectiveness varies, with limited impact in conditions such as postherpetic neuralgia, underscoring the need for tailored pain management strategies. Incorporating dextromethorphan into perioperative protocols demonstrates its potential in reducing opioid reliance, a crucial aspect amid the opioid crisis. This review concludes that dextromethorphan, while requiring further research to fully elucidate its role in pain syndromes and establish comprehensive dosing guidelines, represents a promising adjunct in effective multimodal analgesia, marking a step forward in improving postoperative care and patient satisfaction.