Effect of ketamine as an adjunct to intravenous patient-controlled analgesia, in patients at high risk of postoperative nausea and vomiting undergoing lumbar spinal surgery

Choi²,

et al. 2016

Medicine

Background:Robotic or endoscopic thyroidectomy using bilateral axillo-breast approach (BABA) is frequently performed for excellent cosmesis. However, postoperative pain is remained as concerns due to the extent tissue dissection and tension during the operation. Ketamine is a noncompetitive N-methyl-d-aspartate (NMDA) receptor antagonist that reduces acute postoperative pain. We evaluated the effects of intraoperative ketamine infusion on postoperative pain control and recovery profiles following BABA robotic or endoscopic thyroidectomy.Methods:Fifty-eight adult patients scheduled for BABA robotic or endoscopic thyroidectomy were randomized into a control group (n = 29) and ketamine group (n = 29). Following induction of anesthesia, patients in each group were infused with the same volume of saline or ketamine solution (1 mg/kg bolus, 60 μg/kg/h continuous infusion). Total intravenous anesthesia with propofol and remifentanil was used to induce and maintain anesthesia. Pain scores (101-point numerical rating scale, 0 = no pain, 100 = the worst imaginable pain), the consumption of rescue analgesics, and other postoperative adverse effects were assessed at 1, 6, 24, and 48 hours postoperatively.Results:Patients in the ketamine group reported lower pain scores than those in the control group at 6 hours (30 [30] vs 50 [30]; P = 0.017), 24 hours (20 [10] vs 30 [20]; P < 0.001), and 48 hours (10 [10] vs 20 [15]; P < 0.001) in neck area. No statistically significant differences were found between the 2 groups in terms of the requirements for rescue analgesics or the occurrence of adverse events.Conclusion:Intravenous ketamine infusion during anesthesia resulted in lower postoperative pain scores following BABA robotic or endoscopic thyroidectomy, with no increase in adverse events.

Section: Discussionmentioning

confidence: 99%

Prospective, randomized, and controlled trial on ketamine infusion during bilateral axillo-breast approach (BABA) robotic or endoscopic thyroidectomy

Choi²,

et al. 2016

Medicine

“…Therefore, adjunct analgesic strategy is an alternative to prolong the analgesic duration, decrease the potential risk of side effects by reducing the dose of individual LA. Recently, several neuraxial adjuvants, including clonidine [4], opioids [5]–[7], dexamethasone [8], ketamine [9], magnesium [10], and midazolam [11] have demonstrated the synergistic analgesic effect with LAs with varying degrees of success.…”

Section: Introductionmentioning

confidence: 99%

Does Dexmedetomidine as a Neuraxial Adjuvant Facilitate Better Anesthesia and Analgesia? A Systematic Review and Meta-Analysis

Wang

Jin

et al. 2014

PLoS ONE

BackgroundNeuraxial application of dexmedetomidine (DEX) as adjuvant analgesic has been invetigated in some randomized controlled trials (RCTs) but not been approved because of the inconsistency of efficacy and safety in these RCTs. We performed this meta-analysis to access the efficacy and safety of neuraxial DEX as local anaesthetic (LA) adjuvant.MethodsWe searched PubMed, PsycINFO, Scopus, EMBASE, and CENTRAL databases from inception to June 2013 for RCTs that investigated the analgesia efficacy and safety for neuraxial application DEX as LA adjuvant. Effects were summarized using standardized mean differences (SMDs), weighed mean differences (WMDs) or odds ratio (OR) with suitable effect model. The primary outcomes were postoperative pain intensity and analgesic duration, bradycardia and hypotension.ResultsSixteen RCTs involving 1092 participants were included. Neuraxial DEX significantly decreased postoperative pain intensity (SMD, −1.29; 95% confidence interval (CI), −1.70 to −0.89; P<0.00001), prolonged analgesic duration (WMD, 6.93 hours; 95% CI, 5.23 to 8.62; P<0.00001) and increased the risk of bradycardia (OR, 2.68; 95% CI, 1.18 to 6.10; P = 0.02). No evidence showed that neuraxial DEX increased the risk of other adverse events, such as hypotension (OR, 1.54; 95% CI, 0.83 to 2.85; P = 0.17). Additionally, neuraxial DEX was associated with beneficial alterations in postoperative sedation scores and number of analgesic requirements, sensory and motor block characteristics, and intro-operative hemodynamics.ConclusionNeuraxial DEX is a favorable LA adjuvant with better and longer analgesia. The greatest concern is bradycardia. Further large sample trials with strict design and focusing on long-term outcomes are needed.

“…The 29 RTCs that tested therapies administered during the intraoperative period included systemic pharmacological therapies (19 studies) and locoregional anesthetic drugs (10 studies) (see Table ).…”

Section: Resultsmentioning

confidence: 99%

“…Of the 19 RCTs that studied systemic pharmacological therapies to prevent and treat postoperative pain after lumbar spine procedures, 5 studies tested the use of dexmedetomidine, 5 the use of ketamine, 2 the use tramadol, 2 the use of paracetamol, 2 the use of lidocaine, and 1 study each the use of ketorolac, fentanyl, and NSAIDs (tenoxicam) . Of the 5 RCTs that tested dexmedetomidine, in 2 the use of dexmetomedine did not guarantee lower postoperative pain scores but was able to reduce opioid consumption when compared to placebo or midazolam; in 2 other studies it did not reduce postoperative pain when compared to the control group, and in 1 it was more effective than remifentanil in reducing postoperative pain and patient‐controlled analgesia (PCA) consumption.…”

Section: Resultsmentioning

confidence: 99%

Prevention and Treatment of Postoperative Pain after Lumbar Spine Procedures: A Systematic Review

et al. 2018

Clinical evidence on perioperative pain management in patients undergoing spine procedures have significantly evolved after the review published in 2012. The aim of this systematic review was to report the latest evidence published. These include the preoperative use of dexamethasone, which was shown to be able to reduce pain at mobilization but not to reduce pain at rest or total morphine consumption; the use of gabapentinoids as part of a multimodal analgesic approach; and the safety and effectiveness of the intraoperative use of ketamine, dexketoprofen, and tramadol. Finally, electrical nerve stimulation is gaining interest and is potentially suitable for clinical needs.