Opioid-Sparing Effect of Preemptive Bolus Low-Dose Ketamine for Moderate Sedation in Opioid Abusers Undergoing Extracorporeal Shock Wave Lithotripsy

Gharaei, Babak; Jafari, Alireza; Aghamohammadi, Homayoun; Kamranmanesh, Mohammadreza; Poorzamani, Mahtab; Elyassi, Hedayatollah; Rostamian, Baharak; Salimi, Alireza

doi:10.1213/ane.0b013e31826f0622

Cited by 40 publications

(14 citation statements)

References 33 publications

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“…A pre-emptive bolus dose of ketamine (0.1 mg/kg) has opioid-sparing effects in opioid abusers undergoing moderate sedation [33] . A study of intrinsic functional brain connectivity in twelve healthy volunteers, through resting state functional magnetic resonance imaging, found obvious changes in certain regions of the central nervous system (ie, the amygdala, insula, and anterior cingulate cortex), which could explain ketamine's pharmacodynamic profile with respect to analgesia and its psychedelic side effects [34] .…”

Section: Wwwchinapharcom Gao M Et Almentioning

confidence: 99%

Ketamine use in current clinical practice

2016

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After nearly half a century on the market, ketamine still occupies a unique corner in the medical armamentarium of anesthesiologists or clinicians treating pain. Over the last two decades, much research has been conducted highlighting the drug's mechanisms of action, specifically those of its enantiomers. Nowadays, ketamine is also being utilized for pediatric pain control in emergency department, with its anti-hyperalgesic and anti-inflammatory effects being revealed in acute and chronic pain management. Recently, new insights have been gained on ketamine's potential anti-depressive and antisuicidal effects. This article provides an overview of the drug's pharmacokinetics and pharmacodynamics while also discussing the potential benefits and risks of ketamine administration in various clinical settings.

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Section: Wwwchinapharcom Gao M Et Almentioning

confidence: 99%

Ketamine use in current clinical practice

2016

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“…To overcome inflammatory responses, different drugs are being tried by the technique. These trials cover NSAIDs, opioids, NMDA receptor antagonists and systemic antiepileptics25262728. Stephens et al .…”

Section: Discussionmentioning

confidence: 99%

Impact of Preemptive Analgesia on inflammatory responses and Rehabilitation after Primary Total Knee Arthroplasty: A Controlled Clinical Study

Gao

et al. 2016

Sci Rep

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The aim of this study was to investigate the effects of preemptive analgesia on the inflammatory response and rehabilitation in TKA. 75 patients with unilateral primary knee osteoarthritis were conducted in this prospective study. All patients were randomly divided into two groups (MMA with/without preemptive analgesia group). The following parameters were used to evaluate analgesic efficacy: knee flexion, pain at rest and walking, functional walking capacity (2 MWT and 6 MWT), WOMAC score, and hs-CRP level. Patients in MMA with preemptive analgesia group had lower hs-CRP level and less pain at rest and walking during the first week postoperatively (P < 0.05). The 2 MWT was significantly better in MMA with preemptive analgesia group (17.13 ± 3.82 VS 14.19 ± 3.56, P = 0.001). The 6 MWT scores and WOMAC scores increased significantly within Groups (P = 0.020, 0.000), but no difference between groups postoperatively (P > 0.05). Less cumulative consumption of morphine was found in MMA with preemptive analgesia group at 48 h (P = 0.017, 0.023), but no difference at total requirement (P = 0.113). Preemptive analgesia added to a multimodal analgesic regime improved analgesia, reduced inflammatory reaction and accelerated functional recovery at the first week postoperatively, but not improved long-term function.

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“…As ketamine provides early knee mobilization, it has been reported as a useful adjuvant for perioperative multimodal analgesia in patients undergoing arthroplasty (17). Another randomized, placebocontrolled study stated the opioid-sparing effect of preemptive IV bolus ketamine (18). On the other hand, Lopez-Alvarez et al (19) indicated that morphine consumption and postoperative pain scores were higher in the group in which ketamine was administered.…”

Section: Discussionmentioning

confidence: 99%

Does the Method and Timing of Intravenous Ketamine Administration Affect Postoperative Morphine Requirement After Major Abdominal Surgery?

Biçer¹,

Etı²,

Saraçoğlu³

et al. 2014

Turk J Anesth Reanim

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Original Article / Özgün Araştırma 320 Amaç: Tek doz intravenöz bolus uygulama, postoperatif veya peroperatif infüzyon yoluyla verilmesi ketaminin en çok tercih edilen uygulama yöntemlerindendir. Bununla beraber, ideal ketamin uygulama yöntemi konusunda net bir konsensus bulunmamaktadır. Bu çalışmada, en sık kullanılan ketamin uygulama yöntemleri ve zamanlarının postoperatif opioid tüketimi üzerine olan etkilerini karşılaştırmayı amaçladık.Yöntemler: Kolon kanseri için kolektomi ameliyatı geçirecek 52 hasta randomize olarak 4 gruba ayrıldı. Grup 1 kontrol grubuydu. Grup 2 indüksiyonda 0,5 mg kg -1 tek bolus doz intravenöz ketamin aldı. Grup 3 indüksiyonda 0,5 mg kg -1 bolus intravenöz ketamini takiben 0,25 mg kg -1 sa -1 hızda peroperatif intravenöz ketamin infüzyonu aldı. Grup 4 indüksiyonda 0,5 mg kg -1 bolus intravenöz ketamini takiben 0,25 mg kg -1 sa -1 hızda peroperatif ve postoperatif dönemde intravenöz ketamin infüzyonu aldı. Postoperatif ağrı skorları, yan etkiler ve morfin tüketimleri kaydedildi. Bulgular:Postoperatif ağrı skorlarında istatistiksel olarak anlamlı bir fark yoktu. Grup 4'de diğer gruplarla karşılaştırıldığında toplam morfin tüketimi daha az bulundu (p=0,03, p=0,004, p=0,03, gruplarda sırasıyla). Postoperatif 1, 2 ve 4. saatlerde hasta kontrollü analjeziyle morfin tüketimi Grup 4'de kontrol grubundan anlamlı olarak daha düşüktü (p<0,01).Sonuç: Preoperatif tek bolus doz yada intraoperatif düşük doz ketamin infüzyonu postoperatif morfin tüketimini azaltmamış-ken, per-ve postoperatif 48 saatlik ketamin infüzyonu uygulaması büyük abdominal cerrahi geçiren hastalarda yan etki insidansını artırmadan morfin tüketiminde anlamlı bir azalmayla sonuçlan-mıştır.Anahtar Kelimeler: Ketamin, postoperatif analjezi, kolektomi, morfin Objective: Single intravenous bolus administration and postoperative or perioperative infusions are the most preferred methods of ketamine. Nevertheless, there is no clear explanation on the ideal ketamine administration method. In this study, we aimed to compare the effects of the most common ketamine administration methods and administration time on postoperative opioid consumption. Methods:Fifty-two patients undergoing colectomy for colon cancer were randomly assigned into four groups. Group 1 was the control group. Group 2 received only a single intravenous bolus dose of 0.5 mg kg -1 ketamine at induction. Group 3 received 0.5 mg kg -1 intravenous ketamine bolus at induction and perioperative ketamine infusion at a rate of 0.25 mg kg -1 h -1. Group 4 received a bolus of 0.5 mg kg -1 intravenous ketamine at induction and perioperative and postoperative ketamine infusion at a rate of 0.25 mg kg -1 h -1. Postoperatively, visual analogue scale pain scores, side effects, and morphine consumption were recorded.Results: There was no statistically significant difference in postoperative pain scores. Total morphine consumption was found to be significantly lower in Group 4 compared to the other groups (p=0. 03, p=0.004, p=0.03, respectively). During the 1 st , 2 nd , and 4 th hour...

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Opioid-Sparing Effect of Preemptive Bolus Low-Dose Ketamine for Moderate Sedation in Opioid Abusers Undergoing Extracorporeal Shock Wave Lithotripsy

Abstract: Preemptive low-dose ketamine (0.1 mg/kg) as a bolus has opioid-sparing effects in opioid abusers undergoing moderate sedation.

Cited by 40 publications

References 33 publications

Ketamine use in current clinical practice

Ketamine use in current clinical practice

Impact of Preemptive Analgesia on inflammatory responses and Rehabilitation after Primary Total Knee Arthroplasty: A Controlled Clinical Study

Does the Method and Timing of Intravenous Ketamine Administration Affect Postoperative Morphine Requirement After Major Abdominal Surgery?

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