&lt;![CDATA[&lt;B&gt;Epidural S(+) ketamine and S(+) ketamine-morphine associated with ropivacaine in the postoperative analgesia and sedation of upper abdominal surgery&lt;/B&gt;]]&gt;

Schnaider, Taylor Brandão; Vieira, Antônio Mauro; Brandão, Antônio Carlos Aguiar; Roquim, A

doi:10.1590/s0034-70942007000100002

Cited by 1 publication

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“…Currently, new adjuvants have been used, even as single drug for regional blocks, among them Nmethyl-d-aspartate (NMDA) receptor inhibitors which have ketamine as their primary representative 2,3 , with analgesic properties by inhibiting NMDA, activating monoaminergic descending inhibitory system, activating opioid and cholinergic receptors, in addition to blocking sodium channels similarly to local anesthetics [4][5][6] . Several studies have evaluated the effect of this drug on neuraxis 6,7 , but none of them has analyzed its effect on upper thoracic epidural space, where cardioaccelerator sympathetic branches emerge 8 . Many fear the addition of drugs to this region due to possible local interaction of ketamine with cardioaccelerator fibers with possible direct cardiovascular stimulating effect of sympathetic nervous system 9 , and possible neurotoxicity.…”

Section: Introductionmentioning

confidence: 99%

Estudo comparativo entre cetamina e morfina peridural em pacientes submetidas à mastectomia

Mendonça¹,

Almeida²,

Guimarães³

et al. 2013

Rev. dor

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BACKGROUND AND OBJECTIVES: This study aimed at comparing epidural thoracic S(+) ketamine and morphine, both associated to ropivacaine, for mastectomy procedures. METHODS: This is a prospective study with 26 patients aged between 18 and 70 years, submitted to mastectomy, who were divided into two equal groups. Group M (morphine) patients have received 12 mL of 0.75% ropivacaine associated to 2 mg preservative-free morphine; Group K (ketamine) patients have received 12 mL of 0.75% ropivacaine associated to 50 mg of preservative-free S(+) ketamine. We have evaluated hemodynamic parameters, need for vasopressors, drugs for sedation, pain visual analog scale in the first 24 hours, analgesic and antiemetic consumption, and incidence of nausea and vomiting. RESULTS: There has been no statistical difference between groups in demographics, systolic and diastolic blood pressure, amount of local anesthetics or need for vasopressors. The ketamine group has demanded more midazolam to control sedation (p = 0.0005). This group had lower pain scores at post-anesthetic care unit discharge (p = 0.0018), 12 hours after procedure (p = 0.0001) and 24 hours later (p = 0.0094). The Morphine Group had higher pain scores at post-anesthetic care unit, 12 and 24 postoperative hours, and has demanded more postoperative analgesics (dipirone, p = 0.0009) and antiemetics (metoclopramide, p = 0.0032). CONCLUSION: It has been observed that S(+) ketamine in the evaluated dose was hemodynamically safe and effective, with better performance to control postoperative pain, generating less analgesic consumption as well as lower incidence of nausea and vomiting.

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