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British Journal of Anaesthesia, 2003, Vol. 90, No. 5 653-658
© 2003 The Board of Management and Trustees of the British Journal of Anaesthesia

Clinical Investigations

Dextromethorphan and intrathecal morphine for analgesia after Caesarean section under spinal anaesthesia

D. M. A. Choi1, A. P. Kliffer and M. J. Douglas

Department of Anesthesia, British Columbia Women’s Hospital, Vancouver, British Columbia, Canada 1 Present address: Nuffield Department of Anaesthetics, Oxford Radcliffe Hospitals, Oxford OX3 9DU, UK

Corresponding author. E-mail: Desi.Choi@orh.nhs.uk

Background. Dextromethorphan is an N-methyl-D-aspartic acid antagonist which can attenuate acute pain with few side-effects. In this prospective, randomized, double-blind study of dextromethorphan and intrathecal morphine, we investigated postoperative pain, pruritus, nausea and vomiting in women undergoing Caesarean section under spinal anaesthesia.

Methods. Women were allocated randomly to one of six groups, to receive intrathecal morphine 0.05, 0.1 or 0.2 mg plus oral dextromethorphan 60 mg or placebo.

Results. The addition of dextromethorphan did not reduce postoperative pain scores (P=0.83). Compared with women receiving intrathecal morphine 0.05 mg, women receiving higher doses had a significantly higher incidence of nausea and vomiting [odds ratio for intrathecal morphine 0.1 mg, 4.0 (95% confidence interval 1.2–14.1); for intrathecal morphine 0.2 mg, 7.9 (2.3–27.1)]. Compared with women receiving intrathecal morphine 0.05 mg, women receiving higher doses also had a significantly higher incidence of pruritus [odds ratio for intrathecal morphine 0.1 mg, 3.2 (95% confidence interval 1.3–8.2); for intrathecal morphine 0.2 mg, 3.7 (1.4–9.5)]. Women receiving dextromethorphan had a lower incidence of nausea and vomiting [odds ratio 2.6 (1.1–6.3)].

Conclusions. Postoperative pain after Caesarean section under spinal anaesthesia was not reduced by the addition of oral dextromethorphan to a multimodal approach including intrathecal morphine.

Br J Anaesth 2003; 90: 653–8


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