Preemptive analgesia effects of Ketamine in patients undergoing surgery. A meta-analysis

Yang, Liqiao; Zhang, Jianwei; Zhang, Zheng; Zhang, Chengmi; Zhao, Di; Li, Jingjie

doi:10.1590/s0102-86502014001900009

Cited by 26 publications

(21 citation statements)

References 29 publications

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“…The optimal dose and infusion timing of ketamine for postoperative pain control has not yet been established; however, most trials have used ketamine in subanesthetic doses during the perioperative period. [18] Reviews and meta-analyses that have evaluated the preemptive analgesic effects of ketamine for postoperative pain have concluded that subanesthetic doses of ketamine (0.15–0.5 mg/kg bolus, 60–120 μg/kg/h continuous infusion) result in preemptive analgesic effects that can reduce postoperative opioid usage with no adverse effects. [12,18] …”

Section: Discussionmentioning

confidence: 99%

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Prospective, randomized, and controlled trial on ketamine infusion during bilateral axillo-breast approach (BABA) robotic or endoscopic thyroidectomy

Kim

Choi²,

Kim

et al. 2016

Medicine

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Background:Robotic or endoscopic thyroidectomy using bilateral axillo-breast approach (BABA) is frequently performed for excellent cosmesis. However, postoperative pain is remained as concerns due to the extent tissue dissection and tension during the operation. Ketamine is a noncompetitive N-methyl-d-aspartate (NMDA) receptor antagonist that reduces acute postoperative pain. We evaluated the effects of intraoperative ketamine infusion on postoperative pain control and recovery profiles following BABA robotic or endoscopic thyroidectomy.Methods:Fifty-eight adult patients scheduled for BABA robotic or endoscopic thyroidectomy were randomized into a control group (n = 29) and ketamine group (n = 29). Following induction of anesthesia, patients in each group were infused with the same volume of saline or ketamine solution (1 mg/kg bolus, 60 μg/kg/h continuous infusion). Total intravenous anesthesia with propofol and remifentanil was used to induce and maintain anesthesia. Pain scores (101-point numerical rating scale, 0 = no pain, 100 = the worst imaginable pain), the consumption of rescue analgesics, and other postoperative adverse effects were assessed at 1, 6, 24, and 48 hours postoperatively.Results:Patients in the ketamine group reported lower pain scores than those in the control group at 6 hours (30 [30] vs 50 [30]; P = 0.017), 24 hours (20 [10] vs 30 [20]; P < 0.001), and 48 hours (10 [10] vs 20 [15]; P < 0.001) in neck area. No statistically significant differences were found between the 2 groups in terms of the requirements for rescue analgesics or the occurrence of adverse events.Conclusion:Intravenous ketamine infusion during anesthesia resulted in lower postoperative pain scores following BABA robotic or endoscopic thyroidectomy, with no increase in adverse events.

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Section: Discussionmentioning

confidence: 99%

“…Moreover, the incidence of PONV following thyroidectomy appears to be higher than with other surgeries. [18] …”

Section: Discussionmentioning

confidence: 99%

Prospective, randomized, and controlled trial on ketamine infusion during bilateral axillo-breast approach (BABA) robotic or endoscopic thyroidectomy

Kim

Choi²,

Kim

et al. 2016

Medicine

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“…In the long term, this aims to reduce the postoperative analgesic requirements. 9 After the afferent nociceptive impulses arrive at the spinal cord, the CNS sensitization occurs. The receptor responsible for pain memory is the NMDA receptors.…”

Section: Ketamine and Preemptive Analgesiamentioning

confidence: 99%

Ketamine: old drug, a new option

Chandra

2019

Bali J Anaesthesiol

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“…Di antara Modalitas preemptive analgesia yang ada, NMDA reseptor antagonis merupakan salah satu terapi yang efektif untuk mencegah perkembangan nyeri akut menjadi nyeri kronik. 5 Ketamin adalah noncompetitive nmda reseptor antagonis yang pertama kali disintesis pada tahun 1963 yang digunakan sebagai agen anestesi dan analgesi, mudah didapat,dan harga yang murah. Dosis ketamin yang direkomendasikan untuk preemptive analgesia adalah antara 0,075 mg/kgbb sampai dengan 0,5 mg/kgbb dan rekomendasi yang lain menyebutkan 0,15-0,25 mg/kgbb.…”

Section: Pendahuluanunclassified

Pengaruh Pemberian Pre Emptive Ketamin 0,15 mg/kgbb iv Terhadap Intensitas Nyeri Pasca Operasi Bedah Onkologi Mayor Dengan Anestesi Umum Di RSUD Dr Saiful Anwar Malang

Satiyah

Basuki

Laksono

2015

JAI b

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Latar Belakang : Preemptive analgesia dan multimodal analgesia mempunyai peranan penting dalam penanganan nyeri selama dan pasca operasi dengan memblok jalur nyeri yang terdiri dari tranduksi, transmisi, modulasi dan persepsi. Ketamin sebagai Anti NMDA (N metil D Aspartat) reseptor bekerja memblok jalur transmisi dan modulasi serta sinergis dengan opioid. Ketamin dosis kecil 0,15 mg/kgbb mempunyai efek preemptive analgesia dan tidak memiliki efek samping yang berat.Tujuan : mengetahui pengaruh pemberian preemptive ketamin 0,15 mg/kgbb iv terhadap intensitas nyeri pasca bedah onkologi mayor dengan anestesi umum pada 1,2 dan 3 jam pasca operasiMetode : Penelitian ini merupakan uji klinis acak tersamar ganda, bersifat eksperimental. Sampel penelitian adalah pasien usia 17-40 tahun, kriteria klinis ASA I-II, pendidikan minimal SMP, dan BMI antara 20-30 kg/M2 yang menjalani pembedahan elektif bedah onkologi mayor kategori nyeri sedang yang meliputi operasi struma dan mammae selain radikal mastektomi (MRM). Jumlah sampel adalah 44 pasien yang dibagi secara random menjadi 2 kelompok, yaitu kelompok 1 (perlakuan) yang menerima ketamin 0,15 mg/kgbb dan kelompok 2 (kontrol) tanpa menerima ketamin 0,15mg/kgbb. Semua pasien menerima (multimodal analgesia) yaitu fentanyl (opioid), ketorolac (NSID) dan juga obat2an lain untuk anestesi umum. Intensitas nyeri pada semua sampel diamati pada 1, 2 dan 3 jam pasca operasi dengan menggunakan Verbal numerical rating scale (VNRS) yang setara dengan VAS (visual Analogue scale). Uji statistik normalitas menggunakan uji saphiro wilk diperoleh hasil bahwa data yang ada tidak terdistribusi normal sehingga dilakukan uji beda non parametrik mann whitney testHasil : Penelitian ini menunjukkan bahwa pemberian ketamin 0,15 mg/kgbb mengurangi nyeri akut lebih baik pada 1, 2 dan 3 jam pasca operasi. Pada 1 jam pasca operasi kelompok perlakuan memiliki nilai rerata VAS 0 atau lebih rendah 0,77 cm dbandingkan kelompok kontrol dengan nilai p<0,001. Pada 2 jam pasca operasi kelompok perlakuan memiliki rerata VAS 0,3 cm atau lebih rendah 1,4 cm bila dibandingkan dengan kelompok kontrol dengan nilai p<0,001. Pada 3 jam pasca operasi kelompok perlakuan memiliki rerata 0,9 cm atau lebih rendah 1,6 cm dengan nilai p<0,001.Kesimpulan : Pada penelitian ini preepmtive ketamin 0,15 mg/kgbb iv memberikan pengaruh menurunkan intensitas nyeri pada 1 jam, 2 jam dan 3 jam pasca pembedahan onkologi mayor kategori nyeri sedang.

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Preemptive analgesia effects of Ketamine in patients undergoing surgery. A meta-analysis

Abstract: CONCLUSIONS:Ketamine was able to accomplish some preemptive analgesic effects of reducing postoperative morphine consumption and prolonging the time to first analgesic. Meanwhile, ketamine was as safe as physiological saline in side effects of nausea and vomiting.

Cited by 26 publications

References 29 publications

Prospective, randomized, and controlled trial on ketamine infusion during bilateral axillo-breast approach (BABA) robotic or endoscopic thyroidectomy

Prospective, randomized, and controlled trial on ketamine infusion during bilateral axillo-breast approach (BABA) robotic or endoscopic thyroidectomy

Ketamine: old drug, a new option

Pengaruh Pemberian Pre Emptive Ketamin 0,15 mg/kgbb iv Terhadap Intensitas Nyeri Pasca Operasi Bedah Onkologi Mayor Dengan Anestesi Umum Di RSUD Dr Saiful Anwar Malang

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