Efficacy of Ketamine as an Adjunct to Lidocaine in Intravenous Regional Anesthesia

Abdel‐Ghaffar, Hala Saad; Kalefa, Mahmoud Abdel-Azez; Imbaby, Ahmed Said

doi:10.1097/aap.0000000000000128

Cited by 19 publications

(5 citation statements)

References 13 publications

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“…The analgesic effect of dexamethasone and ketamine in regional nerve block had been reported in several studies. [ 11 12 13 14 ] However, to the best of our knowledge, no clinical studies have examined the comparison between the effects of dexamethasone and ketamine as adjuncts to local anaesthetics in the PVB.…”

Section: Discussionmentioning

confidence: 99%

Effects of adding dexamethasone or ketamine to bupivacaine for ultrasound-guided thoracic paravertebral block in patients undergoing modified radical mastectomy: A prospective randomized controlled study

Mourad

Amer

2018

Indian J Anaesth

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Background and Aims:Pain after modified radical mastectomy (MRM) has been successfully managed with thoracic paravertebral block (TPVB). The purpose of this study was to evaluate the effect of adding dexamethasone or ketamine as adjuncts to bupivacaine in TPVB on the quality of postoperative analgesia in participants undergoing MRM.Methods:This prospective randomised controlled study enrolled ninety adult females scheduled for MRM. Patients were randomised into three groups (30 each) to receive ultrasound-guided TPVB before induction of general anaesthesia. Group B received bupivacaine 0.5% + 1 ml normal saline, Group D received bupivacaine 0.5% + 1 ml dexamethasone (4 mg) and Group K received bupivacaine 0.5% + 1 ml ketamine (50 mg). Patients were observed for 24 h postoperatively to record time to first analgesic demand as a primary outcome, pain scores, total rescue morphine consumption and incidence of complications.Results:Group K had significantly longer time to first analgesic demand than group D and control group (18.0 ± 6.0, 10.3 ± 4.5 and 5.3 ± 3.1 hours respectively; P = 0.0001). VAS scores were significantly lower in group D and group K compared to control group at 6h and 12 h postoperative (p 0.0001 and 0.0001 respectively) while group K had lower VAS at 18 hours compared to other two groups (P = 0.0001). Control group showed the highest mean 24 h opioid consumption (8.9 ± 7.9 mg) compared to group D and group K (3.60 ± 6.92 and 2.63 ± 5.24 mg, P = 0.008,0.001 respectively). No serious adverse events were observed.Conclusion:Ketamine 50 mg or dexamethasone 4 mg added to bupivacaine 0.5% in TPVB for MRM prolonged the time to first analgesic request with no serious side effects.

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Section: Discussionmentioning

confidence: 99%

Effects of adding dexamethasone or ketamine to bupivacaine for ultrasound-guided thoracic paravertebral block in patients undergoing modified radical mastectomy: A prospective randomized controlled study

Mourad

Amer

2018

Indian J Anaesth

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“…Later, the direct action of ketamine on sodium channels at peripheral nerve terminals was theorised [248]. Although ketamine does not play a significant role in pain management, the idea of using ketamine to induce local anaesthesia is intriguing and deserves further investigation [249][250][251][252].…”

Section: − Ketamine As a Local Anaestheticmentioning

confidence: 99%

Narrative Review: Low-Dose Ketamine for Pain Management

Riccardi¹,

Guarino

Serra

et al. 2023

JCM

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Pain is the leading cause of medical consultations and occurs in 50–70% of emergency department visits. To date, several drugs have been used to manage pain. The clinical use of ketamine began in the 1960s and it immediately emerged as a manageable and safe drug for sedation and anesthesia. The analgesic properties of this drug were first reported shortly after its use; however, its psychomimetic effects have limited its use in emergency departments. Owing to the misuse and abuse of opioids in some countries worldwide, ketamine has become a versatile tool for sedation and analgesia. In this narrative review, ketamine’s role as an analgesic is discussed, with both known and new applications in various contexts (acute, chronic, and neuropathic pain), along with its strengths and weaknesses, especially in terms of psychomimetic, cardiovascular, and hepatic effects. Moreover, new scientific evidence has been reviewed on the use of additional drugs with ketamine, such as magnesium infusion for improving analgesia and clonidine for treating psychomimetic symptoms. Finally, this narrative review was refined by the experience of the Pain Group of the Italian Society of Emergency Medicine (SIMEU) in treating acute and chronic pain with acute manifestations in Italian Emergency Departments.

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“…The combination of ketamine with lidocaine for perioperative intravenous regional anesthesia (IVRA) for hand or forearm surgery's also worth mentioning [243], mainly because it may take the place of GA in obese trauma patients. Lidocaine (3 mg/kg/40 mL) alone allowed for the completion of interventions as did the same when coadjuvated with ketamine (50 mg).…”

Section: Peripheral Nerve Root Blocks and Ketaminementioning

confidence: 99%

Role and Advantageousness of Ketamine in Obese and Non-Obese Patients: Peri-Interventional Considerations

Amit

2018

JPT

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Obese and morbidly obese patients are a growing group of individuals that generates medical, social and economicproblems worldwide. They undergo various interventions that require anesthesia and/or analgesia. Despite theirhealthy look, these individuals are graded at high ASA physical status, mainly because of their impaired respiratoryand cardiovascular conditions, and the metabolic changes their body undergoes. Opioids are the default drugsfor perioperative analgesia. Nevertheless, their use has reached a frightening epidemic-like condition worldwide.Multimodal analgesia regimens have been recommended as a perioperative standard of care, particularly useful in theobese. These regimens employ combinations of opioids and non-opioid compounds that reciprocate each analgesicpotencies, thus providing superior pain relief at rest, movement, or on effort, while reducing opioid consumption andtheir concerned adverse effects. The most important perioperative IV adjuvant currently employed is ketamine thatsees resurgence among physicians from diverse medical specialties. After summarizing obese patients’ perioperativedrawbacks, this review will illustrate ketamine’s neuropharmacology, and will describe its therapeutic usefulness asan analgesic adjuvant. Since data regarding the use of the drug in obese patients is scarce, brief exemplifications ofits benefits in non-obese cohorts will be portrayed as well.

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Efficacy of Ketamine as an Adjunct to Lidocaine in Intravenous Regional Anesthesia

Abstract: The addition of ketamine to lidocaine in patients receiving IVRA significantly reduced intraoperative and postoperative analgesic requirements and improved patient satisfaction without causing significant adverse effects.

Cited by 19 publications

References 13 publications

Effects of adding dexamethasone or ketamine to bupivacaine for ultrasound-guided thoracic paravertebral block in patients undergoing modified radical mastectomy: A prospective randomized controlled study

Effects of adding dexamethasone or ketamine to bupivacaine for ultrasound-guided thoracic paravertebral block in patients undergoing modified radical mastectomy: A prospective randomized controlled study

Narrative Review: Low-Dose Ketamine for Pain Management

Role and Advantageousness of Ketamine in Obese and Non-Obese Patients: Peri-Interventional Considerations

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