Pre-emptive oral dextromethorphan reduces both postoperative and packing removal pain in patients undergoing nasal surgery

OBJECTIVE: To determine whether premedication with 45 mg of oral dextromethorphan (DM) given 90 minutes prior to nasal surgery decreases postoperative pain and consequently reduces opioid administration and also, if it reduces the pain of pack removal.

METHODS: This was a prospective, double blind, randomized, controlled study carried out from January 2007 to March 2008 at Al-Moosa General Hospital, Al-Ahsa, Saudi Arabia, in which 38 patients received oral DM (age 28 ± 11 years), and 38 patients received placebos (age 26 ± 10 years). Postoperative pain was assessed using a visual analog scale, and a pain score of >/-5 was treated by a rescue bolus dose of morphine sulfate 2 mg every 10 minutes in the post-anesthesia care unit (PACU) and by one gm of paracetamol in the surgical ward until the score became <5. Pain was also assessed during pack removal.

RESULTS: The placebo group had a higher pain score in the PACU, and hence a higher morphine consumption than the DM group (7.3 mg ± 2.6 versus 4.6 mg ± 1.2, p=0.03). Pain score in the surgical ward was also higher in the placebo group at 4, 8, 12, and 24 hours, but this was insignificant, and was insignificantly lower only at 18 hours (p=0.26). The placebo group had a higher pain score at pack removal than the DM group (7.8 ± 11 versus 3.5 ± 15, p=0.004).

CONCLUSION: Preemptive medication with DM reduces opioid administration in the early postoperative period and during pack removal.