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Preoperative low-dose ketamine has no preemptive analgesic effect in opioid-naïve patients undergoing colon surgery when nitrous oxide is used - a randomized study.

Nistal-Nuño B, Freire-Vila E, Castro-Seoane F, Camba-Rodriguez M - F1000Res (2014)

Bottom Line: We quantified times to rescue analgesic (Paracetamol), adverse effects and patient satisfaction.We found no significant differences in incremental postoperative doses of morphine consumption in bolus, except at 12 h (P =0.013) and 24 h (P =0.002).Preoperative low-dose-ketamine did not show a preemptive analgesic effect or efficacy as an adjuvant for decreasing opioid requirements for postoperative pain in patients receiving intravenous analgesia with morphine after colon surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain.

ABSTRACT

Background: The analgesic properties of ketamine are associated with its non-competitive antagonism of the N-methyl-D-aspartate receptor; these receptors exhibit an excitatory function on pain transmission and this binding seems to inhibit or reverse the central sensitization of pain. In the literature, the value of this anesthetic for preemptive analgesia in the control of postoperative pain is uncertain. The objective of this study was to ascertain whether preoperative low-dose ketamine reduces postoperative pain and morphine consumption in adults undergoing colon surgery.

Methods: In a double-blind, randomized trial, 48 patients were studied. Patients in the ketamine group received 0.5 mg/kg intravenous ketamine before surgical incision, while the control group received normal saline. The postoperative analgesia was achieved with a continuous infusion of morphine at 0.015 mg∙kg-¹∙h-¹ with the possibility of 0.02 mg/kg bolus every 10 min. Pain was assessed using the Visual Analog Scale (VAS), morphine consumption, and hemodynamic parameters at 0, 1, 2, 4, 8, 12, 16, and 24 hours postoperatively. We quantified times to rescue analgesic (Paracetamol), adverse effects and patient satisfaction.

Results: No significant differences were observed in VAS scores between groups (P>0.05), except at 4 hours postoperatively (P=0.040). There were no differences in cumulative consumption of morphine at any time point (P>0.05). We found no significant differences in incremental postoperative doses of morphine consumption in bolus, except at 12 h (P =0.013) and 24 h (P =0.002). The time to first required rescue analgesia was 70 ± 15.491 min in the ketamine group and 44 ± 19.494 min in the control (P>0.05). There were no differences in hemodynamic parameters or patient satisfaction (P>0.05).

Conclusions: Preoperative low-dose-ketamine did not show a preemptive analgesic effect or efficacy as an adjuvant for decreasing opioid requirements for postoperative pain in patients receiving intravenous analgesia with morphine after colon surgery.

No MeSH data available.


Related in: MedlinePlus

Cumulative patient-controlled analgesia (PCA) morphine consumption in the groups during the 24 hours after surgery.(Mean ± SD). There were no significant differences between groups at any time point (P>0.05). The effect of time on total morphine consumption in the postoperative period was not statistically significant (P>0.05).
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f2: Cumulative patient-controlled analgesia (PCA) morphine consumption in the groups during the 24 hours after surgery.(Mean ± SD). There were no significant differences between groups at any time point (P>0.05). The effect of time on total morphine consumption in the postoperative period was not statistically significant (P>0.05).

Mentions: No significant differences were assessed between the two groups in cumulative consumption of morphine at any time point during the first postoperative 24 hours (P>0.05 at all time points).The effect of time on morphine consumption through PCA in the entire postoperative period was not statistically significant (P>0.05). (Figure 2).


Preoperative low-dose ketamine has no preemptive analgesic effect in opioid-naïve patients undergoing colon surgery when nitrous oxide is used - a randomized study.

Nistal-Nuño B, Freire-Vila E, Castro-Seoane F, Camba-Rodriguez M - F1000Res (2014)

Cumulative patient-controlled analgesia (PCA) morphine consumption in the groups during the 24 hours after surgery.(Mean ± SD). There were no significant differences between groups at any time point (P>0.05). The effect of time on total morphine consumption in the postoperative period was not statistically significant (P>0.05).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4309164&req=5

f2: Cumulative patient-controlled analgesia (PCA) morphine consumption in the groups during the 24 hours after surgery.(Mean ± SD). There were no significant differences between groups at any time point (P>0.05). The effect of time on total morphine consumption in the postoperative period was not statistically significant (P>0.05).
Mentions: No significant differences were assessed between the two groups in cumulative consumption of morphine at any time point during the first postoperative 24 hours (P>0.05 at all time points).The effect of time on morphine consumption through PCA in the entire postoperative period was not statistically significant (P>0.05). (Figure 2).

Bottom Line: We quantified times to rescue analgesic (Paracetamol), adverse effects and patient satisfaction.We found no significant differences in incremental postoperative doses of morphine consumption in bolus, except at 12 h (P =0.013) and 24 h (P =0.002).Preoperative low-dose-ketamine did not show a preemptive analgesic effect or efficacy as an adjuvant for decreasing opioid requirements for postoperative pain in patients receiving intravenous analgesia with morphine after colon surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain.

ABSTRACT

Background: The analgesic properties of ketamine are associated with its non-competitive antagonism of the N-methyl-D-aspartate receptor; these receptors exhibit an excitatory function on pain transmission and this binding seems to inhibit or reverse the central sensitization of pain. In the literature, the value of this anesthetic for preemptive analgesia in the control of postoperative pain is uncertain. The objective of this study was to ascertain whether preoperative low-dose ketamine reduces postoperative pain and morphine consumption in adults undergoing colon surgery.

Methods: In a double-blind, randomized trial, 48 patients were studied. Patients in the ketamine group received 0.5 mg/kg intravenous ketamine before surgical incision, while the control group received normal saline. The postoperative analgesia was achieved with a continuous infusion of morphine at 0.015 mg∙kg-¹∙h-¹ with the possibility of 0.02 mg/kg bolus every 10 min. Pain was assessed using the Visual Analog Scale (VAS), morphine consumption, and hemodynamic parameters at 0, 1, 2, 4, 8, 12, 16, and 24 hours postoperatively. We quantified times to rescue analgesic (Paracetamol), adverse effects and patient satisfaction.

Results: No significant differences were observed in VAS scores between groups (P>0.05), except at 4 hours postoperatively (P=0.040). There were no differences in cumulative consumption of morphine at any time point (P>0.05). We found no significant differences in incremental postoperative doses of morphine consumption in bolus, except at 12 h (P =0.013) and 24 h (P =0.002). The time to first required rescue analgesia was 70 ± 15.491 min in the ketamine group and 44 ± 19.494 min in the control (P>0.05). There were no differences in hemodynamic parameters or patient satisfaction (P>0.05).

Conclusions: Preoperative low-dose-ketamine did not show a preemptive analgesic effect or efficacy as an adjuvant for decreasing opioid requirements for postoperative pain in patients receiving intravenous analgesia with morphine after colon surgery.

No MeSH data available.


Related in: MedlinePlus