Abstract
Purpose
To examine whether preincisional dextromethorphan (DM) improved analgesia after modified radical mastectomy (MRM).
Methods
Sixty patients (ASA I–II) scheduled for MRM were included and randomly allocated into two groups. Patients in the treatment group (DM) received 40 mg DM and 20 mg chlorpheniramine maleate (CPM) im, and those in the control group received 20 mg CPMim alone 30 min before skin incision. Meperidine, 1 mg·kg−1 im, was given for postoperative pain relief as required. The time to first meperidine injection, total meperidine consumption, worst pain score, bed-rest time, and side effects were recorded every 24 hr for 48 hr after surgery by a resident anesthesiologist on a double-blind basis.
Results
A longer time to first meperidine injection (19.2 ± 1.6vs 1.5 ± 0.23 hr,P < 0.001) and lower meperidine consumption (0[10]vs 75[50] mg, median [interquartile range],P < 0.001) were observed in the DM group than in the control group. The bed-rest time was shorter in the DM than in the control group (18.0[4]vs 23.0[19] hr,P < 0.001). No difference was noted in worst VAS pain score. Meperidine-related side effects (nausea, vomiting, pruritus, dizziness, headache) were more frequent in the control (10/30) than in the DM group (3/30,P < 0.05). The number of patients who required meperidine injection for pain relief was lower in the DM (7/30) than in the control group (25/30,P < 0.005). No DM- or CPM-associated side effects were observed.
Conclusion
Preincisional IM. DM treatment decreased postoperative pain and opioid requirement after MRM surgery.
Résumé
Objectif
Déterminer si l’administration préincision de dextrométhorphane (DM) améliore l’analgésie à la suite d’une mastectomie radicale modifiée (MRM).
Méthode
Soixante patientes (ASA I–II) qui devaient subir une MRM ont participé à l’étude et ont été réparties au hasard en deux groupes. Les patientes du groupe de traitement (DM) ont reçu 40 mg de DM et 20 mg de maléate de chlorphéniramine (MCP)im, et celles du groupe témoin ont reçu 20 mg de MCPim seulement, 30 min avant l’incision cutanée. De la mépéridine, 1 mg·kg−1 im, a été administrée sur demande après l’opération pour soulager la douleur. Ont été enregistrés par un anesthésiologiste en service selon un mode à double insu : le temps écoulé avant la première injection de mépéridine, la consommation totale de mépéridine, la douleur la plus intense, le temps de repos au lit et les effets secondaires.
Résultats
Un délai plus long avant la première injection de mépéridine (19,2 ± 1,6vs 1,5 ± 0,23 h,P < 0,001) et une plus faible consommation de mépéridine (0[10]vs 75[50] mg, médiane [étendue interquartile],P < 0,001) ont été observés dans le groupe DM comparé au groupe témoin. Le temps de repos au lit a été plus court dans le groupe DM que dans le groupe témoin (18,0[4]vs 23,0[19] h,P < 0,001). Aucune différence n’a toutefois été notée quant à la douleur la plus intense selon I’EVA. Les effets secondaires reliés à la mépéridine (nausées, vomissements, prurit, étourdissements, céphalées) ont été plus fréquents dans le groupe témoin (10/30) que dans le groupe DM (3/30,P < 0,05). Moins de patientes du groupe DM (7/30) que du groupe témoin (25/30) ont demandé une injection de mépéridine pour soulager la douleur,P < 0,005). On n’a pas observé d’effets secondaires associés au DM ou au MCP.
Conclusion
L’administration préincision et intramusculaire de dextrométhorphane a réduit la douleur et les besoins d’opioïdes postopératoires à la suite d’une mastectomie radicale modifiée.
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Supported by grants from the Tri-Service General Hospital (TSGH-C89-40) and National Health Research Institute (NHRI-GT-EX89B909P) of Taiwan, Republic of China.
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Wong, CS., Wu, CT., Yu, JC. et al. Preincisional dextromethorphan decreases postoperative pain and opioid requirement after modified radical mastectomy. Can J Anesth 46, 1122–1126 (1999). https://doi.org/10.1007/BF03015519
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DOI: https://doi.org/10.1007/BF03015519