Effect of the addition of ketamine to morphine in patient‐controlled analgesia

Abstract

SummaryThis randomised, double-blind, prospective study compared morphine (1 mg.m ) with the combination of morphine (1 mg.m )1 ) and ketamine (0.75 mg.m )1 ) via a patient-controlled analgesia system (PCAS) for postoperative pain control. A total of 42 female patients, ASA grade I and II, undergoing elective total abdominal hysterectomy was studied. During a standardised anaesthetic, a loading dose from the PCA syringe of 10 ml.m )2 of body surface area was given. A PCAS with a background infusion was commenced postoperatively. Pain and side-effects were assessed using numerical scoring systems and cardiovascular and respiratory parameters were recorded. There was no statistically significant difference between the groups in total morphine consumption or pain scoring. Side-effect pro®les and time to mobilisation were similar. This study concludes that the addition of ketamine to morphine, in this dosage regimen, administered via PCAS for postoperative pain control, does not confer bene®t following total abdominal hysterectomy.

Beneficial Effects of Adding Ketamine to Intravenous Patient-Controlled Analgesia with Fentanyl after the Nuss Procedure in Pediatric Patients

“…Unlügenç, et al18 studied patients after major abdominal surgery and found that ketamine 1 mg/mL added to tramadol 5 mg/mL IV-PCA (loading dose 1 mg/kg, bolus 0.2 mg/kg, lockout 20 min, background infusion 0.4 mg/kg/h) improved analgesia and reduced tramadol consumption. However, investigating patients undergoing total abdominal hysterectomy, Murdoch, et al19 did not find any benefit of adding ketamine 0.75 mg/mL to morphine 1 mg/mL IV-PCA (10 mL/m 2 body surface area of loading dose, bolus 1 mL, lockout 5 min, background infusion 1 mL/h). Reeves, et al20 found no pain-reducing or morphine-sparing benefits of ketamine bolus 1 mg/mL plus morphine 1 mg/mL IV-PCA (bolus, lockout, and background infusions were determined by the anesthesiologists) in patients after major abdominal surgery.…”

Ketamine added to morphine or hydromorphone patient-controlled analgesia for acute postoperative pain in adults: a systematic review and meta-analysis of randomized trials

“…Supplementary 18,[20][21][22][25][26][27]29,30,32,34,36,40,41,44,45,50 cardiac or thoracic surgery (six trials), 19,23,35,37,38,53 orthopedic surgery (ten trials), 24,28,31,33,39,43,[47][48][49]51 and other surgery (three trials). 42,46,52 General anesthesia was used in 34 trials; one trial used PCA during and after a uterine artery embolization procedure, 29 and one used either general or regional anesthesia.…”

Effect of ketamine on intravenous patient-controlled analgesia using hydromorphone and ketorolac after the Nuss surgery in pediatric patients

“…In regard to pruritus, the incidences in the HO group and the HK group were 7/22 (32%) and 1/22 (5%), respectively, and it was approximately seven times more prevalent in the HO group. Javery et al [25] and Murdoch et al [26] have also reported the reduction of pruritus in the group receiving additional ketamine. Such effects of ketamine have been reported to be due to the suppression of the central sensitization and reduced tolerance to opioid analgesics.…”