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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

Incremental patient-controlled analgesia (PCA) morphine consumption in bolus in both groups during the 24 hours after surgery.(Mean ± SD). There were no statistically significant differences among groups at any time point, except at 12 h (P=0.013) and 24 h (P=0.002).
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f3: Incremental patient-controlled analgesia (PCA) morphine consumption in bolus in both groups during the 24 hours after surgery.(Mean ± SD). There were no statistically significant differences among groups at any time point, except at 12 h (P=0.013) and 24 h (P=0.002).

Mentions: The amount of incremental postoperative doses of morphine consumption in bolus from the PCA was comparable in the two groups. We found no statistically significant differences among groups, except at 12 h (P=0.013) and 24 h (P=0.002). It seems the need of additional boluses of morphine over the basal infusion rate of the PCA was slightly higher in the ketamine group at all time points, except immediately after arrival at the PACU (Figure 3). The total amount of bolus supplements of morphine needed throughout the 24 h was higher in the ketamine group than in the control group (P=0.02). The time to first solicited rescue analgesia was 70 ± 15.491 min in the ketamine group (6 patients) and 44 ± 19.494 min in the control group (5 patients) (P=0.052).


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)

Incremental patient-controlled analgesia (PCA) morphine consumption in bolus in both groups during the 24 hours after surgery.(Mean ± SD). There were no statistically significant differences among groups at any time point, except at 12 h (P=0.013) and 24 h (P=0.002).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f3: Incremental patient-controlled analgesia (PCA) morphine consumption in bolus in both groups during the 24 hours after surgery.(Mean ± SD). There were no statistically significant differences among groups at any time point, except at 12 h (P=0.013) and 24 h (P=0.002).
Mentions: The amount of incremental postoperative doses of morphine consumption in bolus from the PCA was comparable in the two groups. We found no statistically significant differences among groups, except at 12 h (P=0.013) and 24 h (P=0.002). It seems the need of additional boluses of morphine over the basal infusion rate of the PCA was slightly higher in the ketamine group at all time points, except immediately after arrival at the PACU (Figure 3). The total amount of bolus supplements of morphine needed throughout the 24 h was higher in the ketamine group than in the control group (P=0.02). The time to first solicited rescue analgesia was 70 ± 15.491 min in the ketamine group (6 patients) and 44 ± 19.494 min in the control group (5 patients) (P=0.052).

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