Lack of pre‐emptive analgesic effect of (R)‐ketamine in laparoscopic cholecystectomy

Mathisen, Lene Cecilie; Aasbø, Vidar; Ræder, Johan

doi:10.1034/j.1399-6576.1999.430218.x

Cited by 69 publications

(50 citation statements)

References 14 publications

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“…In the studies of Adam et al, 9 Dahl et al, 11 and Mathisen et al, 12 a single dose of iv ketamine was administered either before surgery, or after surgery. There was no evidence of a pre-emptive effect when ketamine was administered before surgery, and the analgesic effect of ketamine when administered at the end of surgery was short-lasting and failed to produce a significant opioid-sparing effect.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have documented an opioid sparing effect of perioperative iv low-dose ketamine 4-8 and others have not. [9][10][11][12][13][14] These discrepancies may be due to the large interstudy variability in surgical procedures, patient population, dose of ketamine administered, timing of administration, and study design. 15,16 In studies that fail to demonstrate a preventive effect of a low-dose ketamine on postoperative pain, the question of whether a lack of efficacy on central sensitization is linked to insufficient pre-or postoperative blockade remains unresolved.…”

Section: Methodsmentioning

confidence: 99%

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Lack of a pre-emptive effect of low-dose ketamine on postoperative pain following oral surgery

Lebrun¹,

Elstraete²,

Sandefo³

et al. 2006

Can J Anesth/J Can Anesth

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Purpose: The aim of this study was to assess the effect of pre-vs postincisional low-dose iv ketamine on postoperative pain in outpatients scheduled for oral surgery under general anesthesia. Methods:Eighty-four patients were randomly assigned to receive intravenously saline before and after surgery in Group 1, ketamine 300 µg·kg -1 iv before and saline after surgery in Group 2, saline before and ketamine 300 µg·kg -1 iv after surgery in Group 3. Postoperative analgesia consisted of iv proparacetamol and ketoprofen. Rescue analgesia consisted of nalbuphine 200 µg·kg -1 iv. Analgesia at home consisted of oral ketoprofen, and acetaminophen with codeine as rescue analgesia. A telephone interview was conducted on the first and second postoperative days.Results: There were no significant differences between groups with respect to pain scores, the number of patients requiring nalbuphine in the postanesthesia care unit (PACU), (36.7%, 38.7%, and 39.5% for Groups 1, 2, and 3 respectively), or nalbuphine consumption in the PACU (66.5 µg·kg -1 ± 16.8, 75.9 µg·kg -1 ± 17.5, 66.7 µg·kg -1 ± 21.6 for Groups 1, 2, and 3 respectively). The number of rescue analgesic tablets taken at home, and time to first request for rescue analgesia, sedation scores, or side-effects were similar amongst groups. No patient required nalbuphine in the ambulatory care unit. Conclusions: There was no benefit to pre-emptive administration of ketamine 300 µg·kg -1 iv whether administered pre-or postoperatively. (36,7 %, 38,7 %, et 39,5 % respectivement pour les Groupes 1, 2 et 3), la consommation de nalbuphine (66,5 µg·kg -1 ± 16,8, 75,9 µg·kg -1 ± 17,5, 66,7 µg·kg -1 ± 21,6 respectivement pour les Groupes 1, 2 et 3), le nombre de comprimés de secours à domicile : 6 (2,13), 7 (2,20), et 7 (1,12) Objectif

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Lack of a pre-emptive effect of low-dose ketamine on postoperative pain following oral surgery

Lebrun¹,

Elstraete²,

Sandefo³

et al. 2006

Can J Anesth/J Can Anesth

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“…Após testar várias combinações de morfina e cetamina racêmica em analgesia controlada pelo paciente (ACP) venosa, um estudo verificou que a relação de 1:1 dessa solução promove melhor efeito analgésico e menos efeitos colaterais em pacientes submetidos a cirurgias espinhais ou de quadril 117 . Entretanto, outros estudos não conseguiram demonstrar esse benefício em outros tipos de procedimento cirúrgico [121][122][123] , com uso de R(-) cetamina 124 ou outras doses de cetamina racêmica utilizadas 112,114 . Em crianças, não foi evidenciada potencialização do efeito de opióides com cetamina racêmica por via venosa em apendicectomias 115 , de maneira semelhante a outra pesquisa após amigdalectomia 125 , contrapondo-se ao resultado positivo citado 97 .…”

Section: Estudos Clínicosunclassified

“…After testing different combinations of morphine and racemic ketamine in patient-controlled intravenous analgesia (PCA), a study has observed that 1:1 ratio of this solution promotes the best analgesic effect with less side effects in patients submitted to hip or spinal surgeries 117 . However, other studies were unable to show this benefit in other surgical procedures [121][122][123] with R(-) ketamine 124 or other racemic ketamine doses 112,114 . Potentiation of opioid effects with intravenous racemic ketamine has not been observed in children during appendicectomy 115 , similar to other study after tonsillectomy 125 , in disagreement with the positive result mentioned 97 .…”

Section: Experimental Studiesmentioning

confidence: 99%

Cetamina e analgesia preemptiva

Oliveira¹,

Sakata²,

Issy³

et al. 2004

Rev. Bras. Anestesiol.

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JUSTIFICATIVA E OBJETIVOS:, pioneiro em usar o termo "analgesia preemptiva", observou redução das alterações centrais quando opióides e anestésicos locais foram administrados isoladamente ou associados antes da incisão cirúrgica, havendo diminuição da intensidade da dor pós-operatória. Os estudos mostram que a anestesia geral promove diminuição da transmissão de impulsos dolorosos periféricos para o sistema nervoso central, porém não é capaz de inibi-los totalmente 3 . Assim, os estímulos nociceptivos provocam sensibilização central, que são responsáveis por aumento da intensidade da dor e do consumo de analgésicos no período pós-operatório. A intensidade da dor pós-operatória depende não somente da incisão cirúrgica, mas também de fatores como: tipo e duração da cirurgia, extensão e natureza da lesão tecidual, atividade farmacológica do agente escolhido, analgesia adicional intra e pós-operatória 4,5 . A analgesia preemptiva visa bloquear ou reduzir a sensibilização central e a dor patológica, diferente da dor fisiológica por ser excessiva em intensidade e induzida por estímulos não dolorosos 6,7 . Recentemente, Kissin 8 relatou que, para uma abordagem analgésica preemptiva correta, é fundamental a verificação da eficácia analgésica de um tratamento e sua duração no período pós-operatório inicial. Por isso, talvez inúmeros estudos tenham falhado em demonstrar efeito preemptivo. Algumas definições de analgesia preemptiva são usadas por diferentes autores, dificultando a avaliação e a comparação de resultados. A analgesia preemptiva é definida de diferentes maneiras: 1-aquela realizada antes do estímulo cirúrgi-co; 2-a que evita a sensibilização central provocada pela incisão cirúrgica; 3-a que evita o estabelecimento de sensibilização central pela incisão cirúrgica e pelo processo inflamatório pós-operatório. A primeira definição pode levar a uma conclusão falsa, pois a analgesia deve ser suficiente para bloquear os impulsos aferentes e não ser, simplesmente, administrada antes da incisão. O segundo conceito expressa a analgesia preemptiva de modo restrito, considerando os fenômenos nociceptivos CETAMINA -ASPECTOS FARMACOLÓGICOSA cetamina, 2-(o-clorofenil)-2-(metilamino)-cicloexanona, foi sintetizada em 1963 por Stevens, sendo usada pela primeira vez em humanos, em 1965, por Corssen e Domino. Essa fenciclidina lipossolúvel possui peso molecular de 238 daltons e pKa de 7,5 9-13 . Pode ser usada clinicamente na forma racêmica ou como isômero levo-rotatório (S+ cetamina). AS(+) cetamina é considerada 3 a 4 vezes mais potente que o isômero dextro-rotatório (R-cetamina) para alívio da dor e em doses equianalgésicas, produz menos alterações psíqui-cas e agitação que as formas racêmica e dextro-rotatória [14][15][16][17][18][19][20][21] . A S(+) cetamina é 2 vezes mais potente que a forma racêmica para prevenir a sensibilização central da medula espinhal 22 . A biodisponibilidade desse agente é de 93% 23 e sua meia-vida plasmática de 186 minutos 24 . Por ser altamente lipossolúvel, apresenta grande volume de distribu...

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“…It has been shown that preincisional infiltration anesthesia with subanesthetic ketamine increases block time, thereby decreasing postoperative analgesic demand (7). The use of ketamine alone as a preventative analgesic remains questionable (8,9).…”

Section: Introductionmentioning

confidence: 99%

The effect of addition of ketamine to lidocaine on postoperative pain in rhinoplasties

Şanlı¹,

Gülhaş²,

Bt³

et al. 2016

Turk J Med Sci

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IntroductionRhinoplasty is a reconstructive surgery that is frequently performed to correct nasal deformities. Local anesthesia alone or local and general anesthesia together can be used in this procedure. Patients experience distinct pain for 3 days after the operation, which is especially severe during the first day (1). Good analgesia should be provided during the postoperative period in order to ensure patient compliance and comfort (2). Local anesthesia is frequently used because it also contributes to analgesia. The addition of vasoconstrictors and adjuvant agents to local anesthetics reduces side effects and facilitates analgesic effect and duration with reduced local anesthetic concentrations. Epinephrine increases the duration of local anesthesia and provides good exposure (3). Agents such as neostigmine, clonidine, or opioids may also be added to increase the duration of anesthesia. However, neostigmine and opioids are not suited for rhinoplasties because they may cause nausea and vomiting, and clonidine is unavailable in many countries (4,5). Therefore, ketamine and its enantiomers are frequently used in multimodal anesthesia approaches. Ketamine has been shown to be better among other adjuvant agents in terms of efficacy and safety, pharmacokinetics, and pharmacodynamics (6).Ketamine allows preventative analgesia via 2 mechanisms: central desensitization due to antihyperalgesic effect and pain control as an N-methyl-daspartate antagonist. It has been shown that preincisional infiltration anesthesia with subanesthetic ketamine increases block time, thereby decreasing postoperative analgesic demand (7). The use of ketamine alone as a preventative analgesic remains questionable (8,9).Lidocaine-epinephrine combinations are used frequently in addition to general anesthesia for intranasal infiltration during rhinoplasty, but, to date, there is no published study on the effect of added ketamine. The objective of our study was to determine the usefulness of subanesthetic ketamine as an adjuvant to the infiltration block in terms of postoperative pain scores, analgesic demand, and patient satisfaction.Background/aim: The objective of this study was to examine the effect of addition of subanesthetic doses of ketamine to an epinephrinelidocaine solution on postoperative pain, analgesic use, and patient comfort during rhinoplasties.Materials and methods: Ninety patients were randomly divided into three groups: Group L, lidocaine with epinephrine; Group K, lidocaine with epinephrine plus ketamine; and Group S (control group), physiological saline solution with epinephrine. The local anesthetic solution was injected as preincisionally with intranasal submucosal infiltration following induction of general anesthesia. We evaluated visual pain score, analgesic demand, Wilson sedation score, and antiemetic demand at 5, 15, and 30 min and 1, 2, 4, 6, 8, 16, and 24 h after the operation. The patient satisfaction score was checked 24 h after the operation.Results: Visual pain score was significantly reduced in Group K in ...

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Lack of pre‐emptive analgesic effect of (R)‐ketamine in laparoscopic cholecystectomy

Abstract: In this study a 1 mg/kg dose of (R)-ketamine given at the end of surgery exerted a short-lasting hypnotic and analgesic effect. The same dose given preoperatively did not show postoperative analgesic effect or pre-emptive effect.

Cited by 69 publications

References 14 publications

Lack of a pre-emptive effect of low-dose ketamine on postoperative pain following oral surgery

Lack of a pre-emptive effect of low-dose ketamine on postoperative pain following oral surgery

Cetamina e analgesia preemptiva

The effect of addition of ketamine to lidocaine on postoperative pain in rhinoplasties

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