Effect of pre-emptive ketamine on sensory changes and postoperative pain after thoracotomy: comparison of epidural and intramuscular routes

Ozyalcin, N.S.; Yücel, Ayşen; Çamlıca, Hakan; Dereli, Necla; Andersen, Ole Kæseler; Arendt‐Nielsen, Lars

doi:10.1093/bja/aeh220

Cited by 49 publications

(35 citation statements)

References 25 publications

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“…Ketamine has been used to reduce post-operative pain following various surgical procedures like hernioraphy [20], abdominal hysterectomy [21], thoracotomy [22], circumcision [23], cesarean section [24], open cholecystectomy [25], appendectomy [26], tonsillectomy [27][28][29][30][31]. Recently ketamine has been used in oral and maxillofacial surgical practice as well [14,[32][33][34][35][36].…”

Section: Discussionmentioning

confidence: 99%

Pre-Emptive Analgesia with Ketamine for Relief of Postoperative Pain After Surgical Removal of Impacted Mandibular Third Molars

Hadhimane

Shankariah

Neswi

2015

J. Maxillofac. Oral Surg.

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Purpose In this study we assessed the clinical efficacy of sub-mucosal injection of ketamine at sub-anesthetic dose of 0.5 mg/kg on post-operative pain, swelling and trismus following surgical extraction of impacted mandibular third molars. Methods Forty bilaterally symmetrical impacted mandibular third molars in 20 patients who required surgical removal were included in the study. Within the same individual, one of the sites received a test medication whereas the other site was used as control. All patients received nerve blocks with local anesthetic (2 % lignocaine hydrochloride with 1:80,000 adrenaline); the Test group received sub-mucosal infiltration of 0.5 mg/kg of ketamine hydrochloride (without preservative) around the impacted mandibular third molar and along the incision line, while the Placebo group received normal saline infiltration, 10 min before placement of the incision. Results The pain scores on VAS at 30 min, 1, 4, 12 h and 1 day post-operatively was significantly lower in the Test group than in the Placebo group (p \ .05). With respect to facial swelling and mouth opening the Test group and Placebo group showed overall no statistically significant difference (p [ .05) on the 1st, 3rd and 7th post-operative days. Conclusion The sub-mucosal injection of 0.5 mg/kg ketamine administered before surgical removal of impacted mandibular third molars was found to be effective in significantly reducing post-operative pain for the first 24 h.

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Section: Discussionmentioning

confidence: 99%

Pre-Emptive Analgesia with Ketamine for Relief of Postoperative Pain After Surgical Removal of Impacted Mandibular Third Molars

Hadhimane

Shankariah

Neswi

2015

J. Maxillofac. Oral Surg.

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“…NMDA receptors antagonists may prevent the acute tolerance to opioids and, among them, ketamine at a blood concentration of 30-120 ng ml -1 is able to strengthen the nociceptives effects of opioids without altering sedation indexes (74). The preoperative administration of 0.1 mg/Kg epidural ketamine reduced the area affected by hyperalgesia and allodynia around the surgical wound in the first 30 days after incision; the same dosage given intramuscolarly did not produce the same effects (75). The limitations to these observations are that the neuropathic lesion and pain could appear after a period longer than expected (76).…”

Section: Intra and Postoperative Analgesiamentioning

confidence: 99%

Post Thoracotomy Pain Syndrome

Corte¹,

Mendola²,

Messina³

et al. 2012

Front Lines of Thoracic Surgery

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“…Un effet préventif est décrit chez l'homme avec de faibles doses de kétamine systémique, cet effet étant perdu à partir du troisième mois [59]. Cela a aussi été montré avec la kétamine administrée par voie péridurale après thoracotomie, où la kétamine systémique (voie intramusculaire) était inefficace, mais à dose manifestement insuffisante [41]. À l'inverse, dans un autre travail mené avec des effectifs supérieurs et une étude détaillée de la douleur neuropathique, la kétamine systémique à plus fortes doses n'avait aucun effet préventif [15].…”

Section: Activation Des Processus Centraux Après Lésion Nerveuse Périunclassified

Douleur chronique postchirurgicale : des pistes pour une prévention ?

Dualé

2009

Douleur analg

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© Springer-Verlag 2009Reçu le 02/12/08, accepté le 30/12/08Résumé La réalité des douleurs chroniques postchirurgicales (DCPC) se fait chaque année plus nette, au fil des études publiées, au point qu'on peut avancer l'idée d'un réel problème de santé publique. Seule la compréhension des mécanismes de ces douleurs, chirurgie par chirurgie, peut faire espérer le développement de stratégies préventives ou curatives précoces. Notamment, la part doit être faite entre ce qui relève de la lésion nerveuse périphérique, de l'algoneurodystrophie, de la sensibilisation médullaire, de la composante supraspinale et de la chronicisation de l'hyperalgésie induite par les opiacés (HIO). Les données concernant les préventions efficaces sont récentes et suggèrent diverses pistes, sans cependant fournir de niveau de preuve élevé.Mots clés Douleur chronique · Chirurgie · Lésion nerveuse périphérique · Algoneurodystrophie · Hyperalgésie · Allodynie Abstract According to the growing literature on the topic, postsurgical chronic pain is currently a reality, which could be identified as a public health problem. To develop any preventive or curative strategy, we need to better understand the mechanisms involved in each surgical procedure. The respective roles of peripheral nerve lesion, complex regional pain syndrome, opiate-induced hyperalgesia, central sensitisation at medullar level, and the supra-spinal part of chronicisation, must be further clarified. The actual data about active preventive treatments are recent and provide interesting perspectives, although the level of evidence still remains low.

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Effect of pre-emptive ketamine on sensory changes and postoperative pain after thoracotomy: comparison of epidural and intramuscular routes

Abstract: The results of the present study demonstrate that pre-emptive epidural ketamine is effective in reducing intra- and postoperative analgesic requirements, hyperalgesia and touch allodynia.

Cited by 49 publications

References 25 publications

Pre-Emptive Analgesia with Ketamine for Relief of Postoperative Pain After Surgical Removal of Impacted Mandibular Third Molars

Pre-Emptive Analgesia with Ketamine for Relief of Postoperative Pain After Surgical Removal of Impacted Mandibular Third Molars

Post Thoracotomy Pain Syndrome

Douleur chronique postchirurgicale : des pistes pour une prévention ?

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