Intraoperative Intravenous Ketamine in Combination with Epidural Analgesia: Postoperative Analgesia After Renal Surgery

Abstract

Renal nociception conducted multisegmentally by both the spinal nerves (T10 to L1) and the vagus nerve cannot be blocked by epidural analgesia alone. We demonstrated that IV ketamine had an improved analgesic or opioid-sparing effect when it was combined with epidural bupivacaine and morphine after renal surgery.

Improvement of Pain Treatment After Major Abdominal Surgery by Intravenous S(+)-Ketamine

“…Our data confirm and extend previous work on pain after abdominal surgery with general and epidural anesthesia (11)(12)(13)(14)(15). The pain scores noted in our placebo and single S(ϩ)-ketamine group were comparable to those reported for epidural anesthesia alone (11)(12)(13)(14)(15).…”

“…The pain scores noted in our placebo and single S(ϩ)-ketamine group were comparable to those reported for epidural anesthesia alone (11)(12)(13)(14)(15). The few trials that have studied IV racemic ketamine, not S(ϩ)-ketamine, however, in this setting cannot be directly compared with our study.…”

“…The authors concluded that larger ketamine doses would provide increased analgesia. When studied at a larger dose after gastrectomy (13) or renal surgery (14), better pain relief was indeed found after an intraoperative racemic ketamine infusion of 0.5 mg · kg Ϫ1 · h Ϫ1 preceded by a preincisional bolus of 1 mg/kg (13) or 0.5 mg/kg (14). After adenocarcinoma surgery, racemic ketamine injected as a 0.5 mg/kg preincisional bolus followed by an infusion of 0.25 mg · kg Ϫ1 · h Ϫ1 reduced morphine needs and caused less residual pain at 6 months after surgery (15).…”

Effects of perioperative intravenous low dose of ketamine on postoperative analgesia in children

“…A caudal block could also play an anti-NMDA role and thereby limit the benefit of adding another anti-NMDA agent such as ketamine. However, some adult studies highlighted a better postoperative analgesia when ketamine was associated with epidural analgesia [8,28,29]. Third, nitrous oxide is known to reduce delayed hyperalgesia induced by inflammation, exaggerated postoperative pain and morphine consumption.…”

“…Third, nitrous oxide is known to reduce delayed hyperalgesia induced by inflammation, exaggerated postoperative pain and morphine consumption. This action of nitrous oxide is mediated by an anti-NMDA effect [29,30]. Its use could, therefore, mask the effect of ketamine.…”