Efficacy of Continuous S(+)-Ketamine Infusion for Postoperative Pain Control: A Randomized Placebo-Controlled Trial

Abstract

Aim. A double-blind, randomized, placebo-controlled trial was designed to evaluate the efficacy of continuous intraoperative infusion of S(+)-ketamine under intravenous anesthesia with target-controlled infusion of remifentanil and propofol for postoperative pain control. Methods. Forty-eight patients undergoing laparoscopic cholecystectomy were assigned to receive continuous S(+)-ketamine infusion at a rate of 0.3 mg·kg−1·h−1 (n = 24, intervention group) or an equivalent volume of saline at the same rate (n = 24, placebo group). The same target-controlled intravenous anesthesia was induced in both groups. Pain was assessed using a 0 to 10 verbal numeric rating scale during the first 12 postoperative hours. Pain scores and morphine consumption were recorded in the postanesthesia care unit (PACU) and at 4 and 12 hours after surgery. Results. Pain scores were lower in the intervention group at all time points. Morphine consumption did not differ significantly between groups during PACU stay, but it was significantly lower in the intervention group at each time point after PACU discharge (P = 0.0061). At 12 hours after surgery, cumulative morphine consumption was also lower in the intervention group (5.200 ± 2.707) than in the placebo group (7.525 ± 1.872). Conclusions. Continuous S(+)-ketamine infusion during laparoscopic cholecystectomy under target-controlled intravenous anesthesia provided better postoperative pain control than placebo, reducing morphine requirement. Trial Registration. This trial is registered with ClinicalTrials.gov NCT02421913.

Postoperative pain management in the postanesthesia care unit: an update

“… 65 Continuous S(+)-ketamine infusion during laparoscopic cholecystectomy provided better postoperative pain control in the PACU than placebo. 66 Racemic mixtures of ketamine are neurotoxic, the neuraxial use of which is strongly discouraged. In fact, a recent study revealed that the addition of ketamine (1 mg/kg) to 0.1% ropivacaine via continuous femoral block with pump infusion after repairing anterior cruciate ligament could not improve postoperative pain control.…”

Parâmetros Eletrocardiográficos De Cães Submetidos À Anestesia Dissociativa E Total Intravenosa Em Procedimento Acadêmico De Ovariossalpingohisterectomia

“…A observação da FC nos cães GA mostra elevação do parâmetro, confirmando a ação simpatomimética da cetamina (MIZIARA et al, 2016). Esse fenômeno simpatomimético pode ser explicado pela interferência do fármaco na receptação de noradrenalina e catecolaminas (SELMI et al 2005).…”

“…A administração de midazolan concomitante à cetamina minimiza o efeito estimulante cardiovascular (CANFRAN, et al,2016), e os fenotiazínicos e opióides promovem bradicardia atenuando a ação do anestésico dissociativo (MIZIARA et al, 2016). Neste estudo, com intenção de minimizar os efeitos da cetamina, no GA (P1) foram administrados na MPA acepromazina e fentanil, porém, ainda percebeu-se presença de elevação no ritmo e frequência cardíaca constante, mas, sem significância durante todos os tempos analisados de transoperatório com o efeito de manipulação abdominal.…”

The Effectiveness of Intraoperative Ketamine and Fentanyl as Preemptive Analgesia Assessed with qNOX Score

“…Study by Miziara et al showed that S(+)-ketamine infusion in laparoscopic cholecystectomy resulted in better postoperative pain control than the placebo group. 17 Therefore, injection of a single dose of ketamine, which acts short-acting both before and after the incision, will not produce analgesia that lasts long into the postoperative period. Besides, setting a constant serum concentration is also needed to achieve the required analgesia effect.…”