Abstract
Objective. Pain control is an essential goal in the management of critical children. Narcotics are the mainstay for pain control. Patients frequently need escalating doses of narcotics. In such cases an adjunctive therapy may be beneficial. Dextromethorphan (DM) is NMDA receptor antagonist and may prevent tolerance to narcotics; however, its definitive role is still unclear. We sought whether dextromethorphan addition could decrease the requirements of fentanyl to control pain in critical children. Design. Double-blind, randomized control trial (RCT). Setting. Pediatric multidisciplinary ICU in tertiary care center. Patients. Thirty-six pediatric patients 2–14 years of age in a multidisciplinary PICU requiring analgesia were randomized into dextromethorphan and placebo. The subjects in both groups showed similarity in most of the characteristics. Interventions. Subjects while receiving fentanyl for pain control received dextromethorphan or placebo through nasogastric/orogastric tubes for 96 hours. Pain was assessed using FLACC and faces scales. Measurements and Main Results. This study found no statistical significant difference in fentanyl requirements between subjects receiving dextromethorphan and those receiving placebo (p = 0.127). Conclusions. Dextromethorphan has no effect on opioid requirement for control of acute pain in children admitted with acute critical care illness in PICU. The registration number for this trial is NCT01553435.
Highlights
Narcotics are the mainstay analgesics to control pain in the intensive care settings
NMDA receptors are implicated in mediating a decrease in narcotic effect and being an NMDA antagonist, dextromethorphan may supplement the pain control by narcotics but this has never been studied in a randomized controlled trial in children admitted in pediatric intensive care unit (PICU) and is still unclear [3, 4], there had been reported results in adult population [5,6,7,8]
Reasons: Case 1: declared brain dead Case 2: fentanyl infusion discontinued Case 3: developed multiple organ failure Case 4: parents requested to withdraw from study Case 5: Fentanyl infusion was discontinued
Summary
Pain control is an essential goal in the management of critical children. Narcotics are the mainstay for pain control. Patients frequently need escalating doses of narcotics. In such cases an adjunctive therapy may be beneficial. We sought whether dextromethorphan addition could decrease the requirements of fentanyl to control pain in critical children. Thirtysix pediatric patients 2–14 years of age in a multidisciplinary PICU requiring analgesia were randomized into dextromethorphan and placebo. The subjects in both groups showed similarity in most of the characteristics. Subjects while receiving fentanyl for pain control received dextromethorphan or placebo through nasogastric/orogastric tubes for 96 hours. Dextromethorphan has no effect on opioid requirement for control of acute pain in children admitted with acute critical care illness in PICU.
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