Adding either dexmedetomidine or ketamine to ropivacaine for serratus anterior plane block after thoracotomy reduces postoperative pain, but ketamine provides greater pain relief. In a randomized trial of 74 adults aged 18–60 undergoing thoracotomy, pain scores were lower in the ketamine group than in the dexmedetomidine group, with statistically significant differences at 1, 12, and 24 hours after surgery. No significant differences were found between groups in blood pressure, heart rate, or mean arterial pressure. Respiratory rate differed significantly at 12 and 24 hours. Both supplements are effective, but ketamine yields more pronounced pain reduction.
A 30-year-old man who consumed 1440 to 1800 mg of dextromethorphan daily for six years—12 to 15 times the maximum recommended dose—was scheduled for elective septorhinoplasty. He had previously been treated for dextromethorphan dependency, with urine levels exceeding 2000 ng/mL, and reported marked dissociative effects from the drug. After abstaining for 48 hours before surgery without major withdrawal symptoms, the authors proceeded with the case, noting dextromethorphan's short half-life and its neuropsychiatric and sympathetic nervous system stimulant effects as an NMDA receptor antagonist. Anesthesiologists should be aware of its clinical pharmacology due to rising recreational abuse among adolescents and young adults.