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Role of N-methyl-D-aspartate receptor antagonists in postoperative pain management

Suzuki, Manzo

Current Opinion in Anaesthesiology: October 2009 - Volume 22 - Issue 5 - p 618–622
doi: 10.1097/ACO.0b013e32832e7af6
Pain medicine: Edited by Raymond Sinatra

Purpose of review In recent years, hundreds of studies have examined the clinical efficacy of N-methyl-D-aspartate (NMDA) receptor antagonists such as ketamine and dextromethorphan as an adjunct to routine postoperative pain management. The purpose of this review is to describe the detail of the study that successfully demonstrated the efficacy of NMDA receptor antagonists.

Recent findings The effect of perioperative ketamine infusion, dextromethorphan, and memantine on postoperative opioid-induced analgesia and prevention of long-term persistent pain is described.

Summary The co-administration of ketamine and morphine as a mixture is not recommended for postoperative pain relief. As an adjunct in multimodal analgesia, low-dose ketamine infusion and the administration of dextromethorphan may be able to improve postoperative pain status. Memantine exhibits the greatest potency among NMDA receptor antagonists. In future, research should consider the perioperative infusion of ketamine followed by long-term administration of memantine for the prevention of persistent pain.

Department of Anesthesiology, Musashikosugi Hospital Nippon Medical School, Kanagawa, Japan

Correspondence to Manzo Suzuki, MD, Department of Anesthesiology, Musashikosugi Hospital Nippon Medical School, Kanagawa 211-8533, Japan Tel: +81 44 396 8038; fax: +81 44 711 8867; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.