Is pre-emptive administration of ketamine a significant adjunction to intravenous morphine analgesia for controlling postoperative pain? A randomized, double-blind, placebo-controlled clinical trial

被引:23
作者
Fiorelli, Alfonso [1 ]
Mazzella, Antonio [1 ]
Passavanti, Beatrice [2 ]
Sansone, Pasquale [2 ]
Chiodini, Paolo [3 ]
Iannotti, Mario [2 ]
Aurilio, Caterina [2 ]
Santini, Mario [1 ]
Pace, Maria Caterina [2 ]
机构
[1] Univ Naples 2, Thorac Surg Unit, I-80100 Naples, Italy
[2] Univ Naples 2, Anesthesiol & Intens Care Unit, I-80100 Naples, Italy
[3] Univ Naples 2, Dept Med & Publ Hlth, I-80100 Naples, Italy
关键词
Ketamine; Post-thoracotomy pain; Analgesia; PATIENT-CONTROLLED ANALGESIA; EPIDURAL ANALGESIA; ADDING KETAMINE; THORACIC-SURGERY; S(+)-KETAMINE; EFFICACY; INFUSION; IMPROVE;
D O I
10.1093/icvts/ivv154
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
To evaluate if the pre-emptive administration of ketamine would potentiate the effect of intravenous morphine analgesia in the management of post-thoracotomy pain. This was a unicentre, double-blind, placebo-controlled, parallel-group, prospective study. Patients were randomly assigned to receive 1 mg/kg ketamine (ketamine group) or an equivalent dose of normal saline (placebo group) before thoracotomy in 1:1 ratio. All patients received postoperatively intravenous morphine administration as additional analgesic regimen. Primary end-point was the pain relief measured with Visual Analogue Scale at rest. The secondary end-points were the reduction of inflammatory response expressed by plasma C-reactive protein levels, the morphine consumption and the rate of side effects. The measurements were carried out 6, 12, 24, 36 and 48 hours postoperatively. A total of 75 patients were randomized of whom 38 were allocated to ketamine group and 37 to placebo group. Baseline characteristics were comparable. Ketamine compared with placebo group showed a significant reduction of pain scores (P = 0.01), C-reactive protein (P < 0.001) and morphine consumption (P < 0.001). No acute psychological side effects related to the use of ketamine were registered. The administration of ketamine before surgery may be an effective adjunct to intravenous morphine analgesia in acute post-thoracotomy pain management. In ketamine group, satisfaction of pain relief was significantly higher with a significant reduction of inflammatory response and morphine consumption compared with placebo group. Our results, if confirmed by larger studies, may be of clinical relevance in situations where epidural analgesia or other analgesic procedures different from systemic opioid analgesia are unavailable or contraindicated.
引用
收藏
页码:284 / 290
页数:7
相关论文
共 24 条
[1]   Intraoperative Infusion of S(+)-Ketamine Enhances Post-thoracotomy Pain Control Compared With Perioperative Parecoxib When Used in Conjunction With Thoracic Paravertebral Ropivacaine Infusion [J].
Argiriadou, Helena ;
Papagiannopoulou, Pinelopi ;
Foroulis, Christophoros N. ;
Anastasiadis, Kyriakos ;
Thomaidou, Eva ;
Papakonstantinou, Christos ;
Himmelseher, Sabine .
JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2011, 25 (03) :455-461
[2]   A prospective randomized controlled study of the efficacy of ketamine for postoperative pain relief in children after adenotonsillectomy [J].
Aspinall, RL ;
Mayor, A .
PAEDIATRIC ANAESTHESIA, 2001, 11 (03) :333-336
[3]   Preemptive intrathecal ketamine injection produces a long-lasting decrease in neuropathic pain behaviors in a rat model [J].
Burton, AW ;
Lee, DH ;
Saab, C ;
Chung, JM .
REGIONAL ANESTHESIA AND PAIN MEDICINE, 1999, 24 (03) :208-213
[4]   Adding ketamine to morphine for intravenous patient-controlled analgesia for acute postoperative pain: a qualitative review of randomized trials [J].
Carstensen, M. ;
Moller, A. M. .
BRITISH JOURNAL OF ANAESTHESIA, 2010, 104 (04) :401-406
[5]   Acute phase responses following minimal access and conventional thoracic surgery [J].
Craig, SR ;
Leaver, HA ;
Yap, PL ;
Pugh, GC ;
Walker, WS .
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2001, 20 (03) :455-463
[6]   A randomized, double blind, placebo controlled clinical trial of the preoperative use of ketamine for reducing inflammation and pain after thoracic surgery [J].
D'Alonzo, Richard C. ;
Bennett-Guerrero, Elliott ;
Podgoreanu, Mihai ;
D'Amico, Thomas A. ;
Harpole, David H. ;
Shaw, Andrew D. .
JOURNAL OF ANESTHESIA, 2011, 25 (05) :672-678
[7]   Ketamine and postoperative pain -: a quantitative systematic review of randomised trials [J].
Elia, N ;
Tramèr, MR .
PAIN, 2005, 113 (1-2) :61-70
[8]   Perioperative Analgesic Efficacy and Plasma Concentrations of S(+)-Ketamine in Continuous Epidural Infusion During Thoracic Surgery [J].
Feltracco, Paolo ;
Barbieri, Stefania ;
Rizzi, Stefano ;
Ori, Carlo ;
Groppa, Francesca ;
De Rosa, Giovanni ;
Frigo, Anna Chiara ;
Padrini, Roberto .
ANESTHESIA AND ANALGESIA, 2013, 116 (06) :1371-1375
[9]   Efficacy of wound analgesia for controlling post-thoracotomy pain: a randomized double-blind study [J].
Fiorelli, Alfonso ;
Izzo, Anna Cecilia ;
Frongillo, Elisabetta Maria ;
Del Prete, Assunta ;
Liguori, Giovanni ;
Di Costanzo, Emilio ;
Vicidomini, Giovanni ;
Santini, Mario .
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2016, 49 (01) :339-347
[10]   Pre-emptive local analgesia in video-assisted thoracic surgery sympathectomy [J].
Fiorelli, Alfonso ;
Vicidomini, Giovanni ;
Laperuta, Paolo ;
Busiello, Luigi ;
Perrone, Anna ;
Napolitano, Filomena ;
Messina, Gaetana ;
Santini, Mario .
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2010, 37 (03) :588-593