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Effects of intraoperative low dose ketamine on remifentanil-induced hyperalgesia in gynecologic surgery with sevoflurane anesthesia.

Hong BH, Lee WY, Kim YH, Yoon SH, Lee WH - Korean J Anesthesiol (2011)

Bottom Line: Ketamine (0.3 mg/kg) was injected and followed with a continuous dosage of 3 µl/kg/min in the ketamine group (n = 20) while the control group was injected and infused with an equal amount of normal saline.We compared postoperative VAS up to 7 hours and morphine demand through PCA.Postoperative VAS and morphine demand was significantly lower in the ketamine group 2 and 3 hours after surgery, respectively.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Deajeon, Korea.

ABSTRACT

Background: Remifentanil is useful during general anesthesia because of its rapid onset and short acting time. However, some studies report that due to opioid-induced hyperalgesia (OIH) and tolerance, remifentanil also increases early postoperative pain. The occurrence of OIH and opioid-induced tolerance is mainly thought to be due to central sensitization by the activation of NMDA receptors. Therefore, we investigated the effects of continuous infusion of ketamine, an NMDA receptor antagonist, on postoperative pain and the quantity of opioids used.

Methods: 40 patients scheduled to undergo laparoscopic gynecologic surgery were randomly allocated into two groups. Anesthesia was equally maintained with sevoflurane and 4 ng/ml of remifentanil in all patients. Ketamine (0.3 mg/kg) was injected and followed with a continuous dosage of 3 µl/kg/min in the ketamine group (n = 20) while the control group was injected and infused with an equal amount of normal saline. We compared postoperative VAS up to 7 hours and morphine demand through PCA.

Results: Postoperative VAS and morphine demand was significantly lower in the ketamine group 2 and 3 hours after surgery, respectively.

Conclusions: When general anesthesia is maintained with sevoflurane and remifentanil in patients undergoing laparoscopic gynecologic surgery, continuous infusion of low dose ketamine decreased early postoperative pain and the quantity of opioids used.

No MeSH data available.


Related in: MedlinePlus

Postoperative pain up to 7 hours after operation. Data are mean ± SD. Group C(control): infused and injected with 0.9% normal saline. Group K (ketamine): infused with ketamine at 3 µg/kg/min after a 0.3 mg/kg loading dose of ketamine. Each time point in group K had a lower VAS score compared to group C (*P < 0.05).
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Figure 2: Postoperative pain up to 7 hours after operation. Data are mean ± SD. Group C(control): infused and injected with 0.9% normal saline. Group K (ketamine): infused with ketamine at 3 µg/kg/min after a 0.3 mg/kg loading dose of ketamine. Each time point in group K had a lower VAS score compared to group C (*P < 0.05).

Mentions: VAS scores overall were lower in the K group, and there were substantial differences within 3 hours after surgery (Fig. 1). When the demand for opioids were divided into intervals according to time, i.e. 0-1 hour and 1-2 hours after surgery, there were significant differences, but not after 2 hours post surgery (Fig. 2).


Effects of intraoperative low dose ketamine on remifentanil-induced hyperalgesia in gynecologic surgery with sevoflurane anesthesia.

Hong BH, Lee WY, Kim YH, Yoon SH, Lee WH - Korean J Anesthesiol (2011)

Postoperative pain up to 7 hours after operation. Data are mean ± SD. Group C(control): infused and injected with 0.9% normal saline. Group K (ketamine): infused with ketamine at 3 µg/kg/min after a 0.3 mg/kg loading dose of ketamine. Each time point in group K had a lower VAS score compared to group C (*P < 0.05).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3198186&req=5

Figure 2: Postoperative pain up to 7 hours after operation. Data are mean ± SD. Group C(control): infused and injected with 0.9% normal saline. Group K (ketamine): infused with ketamine at 3 µg/kg/min after a 0.3 mg/kg loading dose of ketamine. Each time point in group K had a lower VAS score compared to group C (*P < 0.05).
Mentions: VAS scores overall were lower in the K group, and there were substantial differences within 3 hours after surgery (Fig. 1). When the demand for opioids were divided into intervals according to time, i.e. 0-1 hour and 1-2 hours after surgery, there were significant differences, but not after 2 hours post surgery (Fig. 2).

Bottom Line: Ketamine (0.3 mg/kg) was injected and followed with a continuous dosage of 3 µl/kg/min in the ketamine group (n = 20) while the control group was injected and infused with an equal amount of normal saline.We compared postoperative VAS up to 7 hours and morphine demand through PCA.Postoperative VAS and morphine demand was significantly lower in the ketamine group 2 and 3 hours after surgery, respectively.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Deajeon, Korea.

ABSTRACT

Background: Remifentanil is useful during general anesthesia because of its rapid onset and short acting time. However, some studies report that due to opioid-induced hyperalgesia (OIH) and tolerance, remifentanil also increases early postoperative pain. The occurrence of OIH and opioid-induced tolerance is mainly thought to be due to central sensitization by the activation of NMDA receptors. Therefore, we investigated the effects of continuous infusion of ketamine, an NMDA receptor antagonist, on postoperative pain and the quantity of opioids used.

Methods: 40 patients scheduled to undergo laparoscopic gynecologic surgery were randomly allocated into two groups. Anesthesia was equally maintained with sevoflurane and 4 ng/ml of remifentanil in all patients. Ketamine (0.3 mg/kg) was injected and followed with a continuous dosage of 3 µl/kg/min in the ketamine group (n = 20) while the control group was injected and infused with an equal amount of normal saline. We compared postoperative VAS up to 7 hours and morphine demand through PCA.

Results: Postoperative VAS and morphine demand was significantly lower in the ketamine group 2 and 3 hours after surgery, respectively.

Conclusions: When general anesthesia is maintained with sevoflurane and remifentanil in patients undergoing laparoscopic gynecologic surgery, continuous infusion of low dose ketamine decreased early postoperative pain and the quantity of opioids used.

No MeSH data available.


Related in: MedlinePlus