Pre-Incisional Analgesia with Intravenous or Subcutaneous Infiltration of Ketamine Reduces Postoperative Pain in Patients after Open Cholecystectomy: A Randomized, Double-Blind, Placebo-Controlled Study

Safavi, Mohammadreza; Honarmand, Azim; Nematollahy, Zahra

doi:10.1111/j.1526-4637.2011.01205.x

Cited by 39 publications

(36 citation statements)

References 37 publications

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“…Our study showed that intravenous and subcutaneous administration of low dose ketamine reduced not only the post-operative pain score, but also analgesic requirement after tonsillectomy. The results of previous studies in adults using low dose intravenous ketamine preemptively, demonstrated decreased pain scores and also reduced postoperative analgesic requirement (9,10,17). Although, the route and the time of the drug administration were different, still the results are contradictory regarding preemptive effects (7).…”

Section: Discussionmentioning

confidence: 84%

“…Preschool patients are affected from undesirable effects of postoperative pain more than adults (8). It has been shown that using ketamine in children, as an analgesic could reduce the consumption of other analgesic drugs such as opioids, leading to fewer adverse effects (7,9,10). Both interception of nociceptive input and blockage of N-methyl-d-aspartate (NMDA) activation may be necessary for preventive analgesia.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of a Low Dose Ketamine in Post Tonsillectomy Pain Relief: A Randomized Trial Comparing Intravenous and Subcutaneous Ketamine in Pediatrics

Javid¹,

Hajijafari²,

Hajipour³

et al. 2012

anesthpain

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It is useful for the medical education fields and all who are interested in that.Background: Pain control in children is still a therapeutic dilemma. Preschool patients are affected from undesirable effects of postoperative pain more than adults. Tonsillectomy is associated with a high incidence of postoperative pain, not only complicating the recovery, but also delaying patients discharge. Objectives: Despite employing different surgical and anesthetic strategies in post-tonsillectomy pain relief, this is still a clinical problem. The study was designed to evaluate the efficacy of a low dose ketamine in post tonsillectomy pain relief. Patients and Methods: Our prospective randomized double blinded study enrolled 75 pediatric patients (3-10 years old) who were scheduled for a tonsillectomy procedure. Patients were randomly assigned to one of three groups receiving; intravenous (IV) ketamine 0.5mg/kg, subcutaneous (SC) ketamine 0.5 mg/kg and placebo at the end of the operation. Post-operative pain score was assessed using modified CHEOPS. Results: In our study we did not find any significant difference among the three groups regarding sex, age, and weight, duration of operation, hemodynamic stability, and nausea and vomiting. However, in ketamine groups, pain score and analgesic consumption were significantly lower (P < 0.00). The efficacy of the both ketamine groups was similar. Conclusions: The study demonstrated that the both subcutaneous and intravenous injections of ketamine, at the end of the operation, were safe and effective for post-tonsillectomy pain control. Ketamine reduced postoperative analgesic medications consumption without increasing the risk of complications.

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Section: Discussionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Evaluation of a Low Dose Ketamine in Post Tonsillectomy Pain Relief: A Randomized Trial Comparing Intravenous and Subcutaneous Ketamine in Pediatrics

Javid¹,

Hajijafari²,

Hajipour³

et al. 2012

anesthpain

View full text Add to dashboard Cite

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“…Ketamine has been used to reduce post-operative pain following various surgical procedures like hernioraphy [20], abdominal hysterectomy [21], thoracotomy [22], circumcision [23], cesarean section [24], open cholecystectomy [25], appendectomy [26], tonsillectomy [27][28][29][30][31]. Recently ketamine has been used in oral and maxillofacial surgical practice as well [14,[32][33][34][35][36].…”

Section: Discussionmentioning

confidence: 99%

“…Atashkhoyi et al [24] evaluated the efficacy of pre-incisional subcutaneous infiltration of low-dose ketamine at the site of incision after cesarean section and reported decreased postoperative pain scores with a significant decrease of analgesics consumption. Safavi et al [25] concluded that a 2 mg/kg dose of Fig. 3 Comparision of mouth opening between Test group and Placebo group subcutaneous infiltration ketamine or 1 mg/kg dose of intravenous ketamine given at approximately 15 min before surgery provides an adjunctive analgesia for 24 h after surgery in patients undergoing cholecystectomy surgery.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast to these reports Pedersen et al [37] examined the analgesic effect of local ketamine infiltration, compared with placebo and systemic ketamine, in a human model of inflammatory pain induced by a burn and showed that though local ketamine infiltration reduced pain during the burn injury compared with systemic treatment and placebo, no difference between local ketamine and placebo could be detected 1 and 2 h after the burn and hence concluded that a clinically relevant effect of peripheral ketamine in acute pain seems unlikely. Few studies have compared the efficacy of ketamine administered through different routes and the results have been varying [25,38]. Dal et al [28] compared same dose of peritonsillar infiltration of ketamine with iv ketamine and found no statistically significant difference in pain scores in both the groups of patients undergoing adenotonsillectomy.…”

Section: Discussionmentioning

confidence: 99%

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Pre-Emptive Analgesia with Ketamine for Relief of Postoperative Pain After Surgical Removal of Impacted Mandibular Third Molars

Hadhimane

Shankariah

Neswi

2015

J. Maxillofac. Oral Surg.

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Purpose In this study we assessed the clinical efficacy of sub-mucosal injection of ketamine at sub-anesthetic dose of 0.5 mg/kg on post-operative pain, swelling and trismus following surgical extraction of impacted mandibular third molars. Methods Forty bilaterally symmetrical impacted mandibular third molars in 20 patients who required surgical removal were included in the study. Within the same individual, one of the sites received a test medication whereas the other site was used as control. All patients received nerve blocks with local anesthetic (2 % lignocaine hydrochloride with 1:80,000 adrenaline); the Test group received sub-mucosal infiltration of 0.5 mg/kg of ketamine hydrochloride (without preservative) around the impacted mandibular third molar and along the incision line, while the Placebo group received normal saline infiltration, 10 min before placement of the incision. Results The pain scores on VAS at 30 min, 1, 4, 12 h and 1 day post-operatively was significantly lower in the Test group than in the Placebo group (p \ .05). With respect to facial swelling and mouth opening the Test group and Placebo group showed overall no statistically significant difference (p [ .05) on the 1st, 3rd and 7th post-operative days. Conclusion The sub-mucosal injection of 0.5 mg/kg ketamine administered before surgical removal of impacted mandibular third molars was found to be effective in significantly reducing post-operative pain for the first 24 h.

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Perioperative intravenous ketamine for acute postoperative pain in adults

Brinck

Tiippana

Heesen

et al. 2018

CDSR

187

134

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Data collection and analysis Two review authors searched for studies, extracted efficacy and adverse event data, examined issues of study quality and potential bias, and performed analyses. Primary outcomes were opioid consumption and pain intensity at rest and during movement at 24 and 48 hours postoperatively. Secondary outcomes were time to first analgesic request, assessment of postoperative hyperalgesia, central nervous system (CNS) adverse effects, and postoperative nausea and vomiting. We assessed the evidence using GRADE and created a 'Summary of findings' table. Main results We included 130 studies with 8341 participants. Ketamine was given to 4588 participants and 3753 participants served as controls. Types of surgery included ear, nose or throat surgery, wisdom tooth extraction, thoracotomy, lumbar fusion surgery, microdiscectomy, hip joint replacement surgery, knee joint replacement surgery, anterior cruciate ligament repair, knee arthroscopy, mastectomy, haemorrhoidectomy, abdominal surgery, radical prostatectomy, thyroid surgery, elective caesarean section, and laparoscopic surgery. Racemic ketamine bolus doses were predominantly 0.25 mg to 1 mg, and infusions 2 to 5 µg/kg/minute; 10 studies used only S-ketamine and one only R-ketamine. Risk of bias was generally low or uncertain, except for study size; most had fewer than 50 participants per treatment arm, resulting in high heterogeneity, as expected, for most analyses. We did not stratify the main analysis by type of surgery or any other factor, such as dose or timing of ketamine administration, and used a non-stratified analysis. Perioperative intravenous ketamine reduced postoperative opioid consumption over 24 hours by 8 mg morphine equivalents (95% CI 6 to 9; 19% from 42 mg consumed by participants given placebo, moderate-quality evidence; 65 studies, 4004 participants). Over 48 hours, opioid consumption was 13 mg lower (95% CI 10 to 15; 19% from 67 mg with placebo, moderate-quality evidence; 37 studies, 2449 participants). Perioperative intravenous ketamine reduced pain at rest at 24 hours by 5/100 mm on a visual analogue scale (95% CI 4 to 7; 19% lower from 26/100 mm with placebo, high-quality evidence; 82 studies, 5004 participants), and at 48 hours by 5/100 mm (95% CI 3 to 7; 22% lower from 23/100 mm, high-quality evidence; 49 studies, 2962 participants). Pain during movement was reduced at 24 hours (6/100 mm, 14% lower from 42/100 mm, moderate-quality evidence; 29 studies, 1806 participants), and 48 hours (6/100 mm, 16% lower from 37 mm, low-quality evidence; 23 studies, 1353 participants). Results for primary outcomes were consistent when analysed by pain at rest or on movement, operation type, and timing of administration, or sensitivity to study size and pain intensity. No analysis by dose was possible. There was no difference when nitrous oxide was used. We downgraded the quality of the evidence once if numbers of participants were large but small-study effects were present, or twice if numbers were small and small-study effects likel...

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Pre-Incisional Analgesia with Intravenous or Subcutaneous Infiltration of Ketamine Reduces Postoperative Pain in Patients after Open Cholecystectomy: A Randomized, Double-Blind, Placebo-Controlled Study

Abstract: A 2 mg/kg dose of subcutaneous infiltration ketamine or 1 mg/kg dose of intravenous ketamine given at approximately 15 minutes before surgery provides an adjunctive analgesia during 24 hours after surgery in patients undergoing cholecystectomy surgery.

Cited by 39 publications

References 37 publications

Evaluation of a Low Dose Ketamine in Post Tonsillectomy Pain Relief: A Randomized Trial Comparing Intravenous and Subcutaneous Ketamine in Pediatrics

Evaluation of a Low Dose Ketamine in Post Tonsillectomy Pain Relief: A Randomized Trial Comparing Intravenous and Subcutaneous Ketamine in Pediatrics

Pre-Emptive Analgesia with Ketamine for Relief of Postoperative Pain After Surgical Removal of Impacted Mandibular Third Molars

Perioperative intravenous ketamine for acute postoperative pain in adults

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