Intraartikuläre Ketamingabe bei arthroskopischen Knieoperationen

Börner, Martine Bonhôte; Bürkle, Hartmut; Trojan, S.; Horoshun, G.; Riewendt, H.D.; Wappler, Frank

doi:10.1007/s00101-007-1249-y

Cited by 18 publications

(12 citation statements)

References 30 publications

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“…[29] Ketamine has been applied either alone or as an intraarticular adjuvant. [5,16] Several studies have confirmed the efficacy of intraarticular ketamine in postoperative pain treatment after arthroscopic knee surgery, [4,30] whereas the conflicting results are observed in another study. [31] Our meta-analysis concludes that ketamine supplementation is associated with remarkably reduced pain scores within 2 hours, analgesic consumption, and prolonged time to first analgesic requirement for knee arthroscopy.…”

Section: Discussionmentioning

confidence: 99%

The efficacy of ketamine supplementation on pain management for knee arthroscopy

Pan¹,

Shen²,

et al. 2019

Medicine

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Introduction: The efficacy of ketamine supplementation on pain management for knee arthroscopy remains controversial. We conduct a systematic review and meta-analysis to explore the influence of ketamine supplementation for knee arthroscopy. Methods: We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through October 2018 for randomized controlled trials (RCTs) assessing the effect of ketamine supplementation on pain control for knee arthroscopy. This meta-analysis is performed using the random-effect model. Results: Seven RCTs involving 300 patients are included in the meta-analysis. Overall, compared with control group for knee arthroscopy, ketamine supplementation reveals favorable impact on pain scores (mean difference [MD] = –2.95; 95% confidence interval [CI] = –3.36 to –2.54; P < .00001), analgesic consumption (standard mean difference [Std. MD] = –1.03; 95% CI = –1.70 to –0.36; P = .002), time to first analgesic requirement (Std. MD = 1.21; 95% CI = 0.45–1.96; P = .002) and malondialdehyde (Std. MD = –0.63; 95% CI = –1.05 to 3.10; P = –.20), and shows no increase in nausea and vomiting (RR = 1.87; 95% CI = 0.65–3.10; P = .003). Conclusions: Ketamine supplementation benefits to pain management and may reduce ischemia reperfusion injury in patients with knee arthroscopy.

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Section: Discussionmentioning

confidence: 99%

The efficacy of ketamine supplementation on pain management for knee arthroscopy

Pan¹,

Shen²,

et al. 2019

Medicine

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“…118 IA ketamine with local anesthetic demonstrates conflicting effects on pain scores and opioid use when compared to local anesthetics alone in arthroscopic knee surgeries. 119,120 IA morphine and ketorolac in addition to ropivacaine improved pain control versus ropivacaine alone 121 but not versus bupivacaine alone. 31 In hip surgery, IA clonidine injection in addition to local anesthetic did not however show a difference in pain scores or opioid consumption versus local anesthetic alone.…”

Section: Resultsmentioning

confidence: 95%

Preventive Analgesia by Local Anesthetics

Barreveld

Witte

Chahal³

et al. 2013

Anesthesia &Amp; Analgesia

145

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The use of local anesthetics to reduce acute postoperative pain has a long history, but recent reports have not been systematically reviewed. In addition, the need to include only those clinical studies that meet minimum standards for randomization and blinding must be adhered to. In this review we have applied stringent clinical study design standards to identify publications on the use of perioperative local anesthetics. We first examined several types of peripheral nerve blocks, covering a variety of surgical procedures, and second, for effects of intentionally administered IV local anesthetic (lidocaine) for suppression of postoperative pain. Thirdly, we have examined publications in which vascular concentrations of local anesthetics were measured at different times after peripheral nerve block procedures, noting the incidence when those levels reached ones achieved during intentional IV administration. Importantly, the very large number of studies using neuraxial blockade techniques (epidural, spinal) has not been included in this review but will be dealt with separately in a later review. The overall results showed a strongly positive effect of local anesthetics, by either route, for suppressing postoperative pain scores and analgesic (opiate) consumption. In only a few situations were the effects equivocal. Enhanced effectiveness with the addition of adjuvants was not uniformly apparent. The differential benefits between drug delivery before, during, or immediately after a surgical procedure are not obvious, and a general conclusion is that the significant antihyperalgesic effects occur when the local anesthetic is present during the acute postoperative period, and its presence during surgery is not essential for this action.

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“…However, the results about the required dose and volume for administration are controversial. Huang et al[ 7 ] found that 5 mL of 0.5 mg.kg -1 intraarticular ketamine had no beneficial effect on pain scores in the first 24 h postoperatively, while Borner et al[ 10 ] demonstrated that 0.25 mg/kg intraarticular ketamine in a total volume of 10 mL effectively decreased pain scores and reduced analgesic requirement. We found that although 0.5 mg.kg -1 intraarticular ketamine in 20 mL volume combined with periarticular 10 mL 0.5% bupivacaine prolonged the time to first analgesic requirement, it had no effect on pain scores and analgesic consumption, while 1 mg.kg -1 intraarticular ketamine significantly reduced VAS scores at rest and movement and morphine consumption in the early postoperative period.…”

Section: Discussionmentioning

confidence: 99%

“…Controversial results have been published on the analgesic efficiency of intraarticular ketamine depending on the administered dose and the combination drug. [ 4 , 7 - 10 ] Huang et al[ 7 ] used 0.5 mg.kg -1 intraarticular ketamine on postoperative arthroscopic knee surgery and found no improvement in analgesia. In contrast, Salman et al[ 8 ] have compared the analgesic effect of intraarticular tramadol, magnesium, and ketamine after arthroscopic meniscectomy.…”

Section: Introductionmentioning

confidence: 99%

Effects of intraarticular ketamine combined with periarticular bupivacaine on postoperative pain after arthroscopic meniscectomy

et al. 2020

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Objectives This study aims to evaluate the effects of two different doses of intraarticular ketamine on visual analog scale (VAS) scores at rest and movement, time to first analgesic requirement, and 24-h morphine consumption in patients undergoing arthroscopic meniscectomy as well as to assess the frequency of postoperative nausea&vomiting, respiratory depression, pruritus, urinary retention, and constipation and to compare the time to discharge. Patients and methods This prospective randomized double- blind study was performed between August 2013 and August 2014 on 75 patients (32 males, 43 females; mean age 46.7±13 years; range, 18 to 75 years) with American Society of Anesthesiologists scores of I-II scheduled for unilateral meniscectomy. Patients were randomized to receive 0.5 mg.kg -1 ketamine (group K1), 1 mg.kg -1 ketamine (group K2) or saline (group S) to a total volume of 20 mL intraarticularly at the end of the surgery. All patients were performed periarticular 10 mL 0.5% bupivacaine infiltration. Visual analog scale at rest and during passive knee movement was used to evaluate pain both preoperatively and at postoperative 0, 30 min, and 1, 2, 4, 6, 12, and 24 h. Time to first analgesic requirement and morphine consumption were recorded. Results Visual analog scale scores at rest and during movement at postoperative 0 were significantly reduced in group K2 compared with group S (p<0.05). The first analgesic requirement time was significantly longer in group K1 (76.9±25.2 min) and group K2 (93.4±26.1 min) than group S (29.3±7.1 min). Morphine consumption was lower in group K2 compared to group K1 and group S at postoperative 30 min, and 1 and 2 h. However, 24-h morphine consumption was similar in all groups. Conclusion Intraarticular injection of 0.5 mg.kg -1 and 1 mg.kg -1 ketamine for postoperative pain management provided similar analgesic efficacy. However, high dose ketamine more noticeably decreased opioid requirement in the early postoperative period.

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Intraartikuläre Ketamingabe bei arthroskopischen Knieoperationen

Cited by 18 publications

References 30 publications

The efficacy of ketamine supplementation on pain management for knee arthroscopy

The efficacy of ketamine supplementation on pain management for knee arthroscopy

Preventive Analgesia by Local Anesthetics

Effects of intraarticular ketamine combined with periarticular bupivacaine on postoperative pain after arthroscopic meniscectomy

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