Effect of i.v. ketamine in combination with epidural bupivacaine or epidural morphine on postoperative pain and wound tenderness after renal surgery

Abstract

We studied 60 patients undergoing operation on the kidney with combined general and epidural anaesthesia, in a double-blind, randomized, controlled study. Patients were allocated to receive a preoperative bolus dose of ketamine 10 mg i.v., followed by an i.v. infusion of ketamine 10 mg h-1 for 48 h after operation, or placebo. During the first 24 h after surgery, all patients received 4 ml h-1 of epidural bupivacaine 2.5 mg ml-1. From 24 to 48 h after operation, patients received epidural morphine 0.2 mg h-1 preceded by a bolus dose of 2 mg. In addition, patient-controlled analgesia (PCA) with i.v. morphine (2.5 mg, lockout time 15 min) was offered from 0 to 48 h after operation. Patients who received ketamine felt significantly more sedated at 0-24 h, but not at 24-48 h after operation, compared with patients who received placebo (P = 0.002 and P = 0.127, respectively). There were no significant differences in pain (VAS) at rest, during mobilization or cough, PCA morphine consumption, sensory block to pinprick, pressure pain detection threshold assessed with an algometer, touch and pain detection thresholds assessed with von Frey hairs, peak flow or side effects other than sedation. The power of detecting a reduction in VAS scores of 20 mm in our study was 80% at the 5% significance level. We conclude that we were unable to demonstrate an (additive) analgesic or opioid sparing effect of ketamine 10 mg h-1 i.v. combined with epidural bupivacaine at 0-24 h, or epidural morphine at 24-48 h after renal surgery.

Preincisional intravenous low-dose ketamine and local infiltration with ropivacaine reduces postoperative pain after laparoscopic cholecystectomy

“…In upper abdominal surgery, therefore, multiple blockades of afferent nociception may be necessary to attain definitive preemptive analgesia. Although previous studies have shown that preemptive application of low-dose IV ketamine reduces postoperative pain and the consumption of opioids [8,10], we were not able to find any study examining the effect of the combination we used (ropivacaine + ketamine).…”

“…The visceroperitoneal organs are innervated multiply by the spinal nerves T5-T12 [13], the vagus nerve [5,6,14], and the phrenic nerve (C3-C5) [8,13] in the upper abdomen. All of these nerves are closely associated with visceroperitoneal nociception.…”

“…Bisgaard et al have shown that local infiltration with ropivacaine reduces incisional pain but has no effect on deep intraabdominal pain [4]. Dahl et al [7] and Illkajer et al [8] found that IV low-dose ketamine had no significant preemptive effect. This may be the result of the low dosage in addition to the insufficient effect of IV ketamine when it is used alone as a preemptive analgesic regimen.…”

Ketamine as an Adjunct to Postoperative Pain Management in Opioid Tolerant Patients after Spinal Fusions: A Prospective Randomized Trial

“…The Cochrane review of ketamine for postoperative pain reported in 27 of 37 reviewed trials ketamine reduced opioid analgesic requirements or pain intensity, or both [14]. Four of these trials included a preincisional bolus of ketamine (10 mg, 0.15 mg/kg, ) for 24 postoperative hours [2,[14][15][16][17][18]. The four trials included major abdominal surgery.…”

Diz Protez Cerrahisinde Preinsizyonel ve Postinsizyonel Epidural, Bupivakain Verapamil ve Ketamin Postoperatif Analjezik Tüketimine Etkileri

“…Santral sensitizasyon ketamin ve dekstrometorfan gibi NMDA reseptör antagonistleri yanında, hücre içine kalsiyum girişini engelleyen verapamil gibi kalsiyum kanal blokerleri ile de önlenebilir. Nitekim klinikte kullanılabilen bir NMDA antagonisti olan ketaminin postoperatif ağrıyı ve postoperatif hasta kontrollü morfin tüketimini (HKA) azalttığını göste-ren klinik çalışmalar bulunmaktadır (10)(11)(12)(13)(14)(15). Kalsiyum kanal blokerlerinin de hayvan deneylerinde antinosiseptif etki sağladığı, kronik ağrısı olan vakalarda morfin analjezisini potansiyalize ettiği ve akut postoperatif ağrıda hasta kontrollü analjezi ile opioid tüketimini azalttığını gösteren çalışmalar mevcuttur (4,5,(16)(17)(18).…”