Preincisional administration of intravenous or subcutaneous infiltration of low-dose ketamine suppresses postoperative pain after appendectomy

Honarmand, Azim; Safavi, Mohammadreza; Karaky, Hasan

doi:10.2147/jpr.s26476

Cited by 13 publications

(17 citation statements)

References 25 publications

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“…Preincisional IV administration of low-dose ketamine provides analgesia for 24 hours after surgery without significant side effects in patients undergoing appendectomy, whereas SC ketamine at the same dose only controls analgesia within the first 6 hours after surgery. 57 …”

Section: Resultsmentioning

confidence: 99%

The optimal choice of medication administration route regarding intravenous, intramuscular, and subcutaneous injection

Jin¹,

Zhu²,

Chen³

et al. 2015

PPA

131

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BackgroundIntravenous (IV), intramuscular (IM), and subcutaneous (SC) are the three most frequently used injection routes in medication administration. Comparative studies of SC versus IV, IM versus IV, or IM versus SC have been sporadically conducted, and some new findings are completely different from the dosage recommendation as described in prescribing information. However, clinicians may still be ignorant of such new evidence-based findings when choosing treatment methods.MethodsA literature search was performed using PubMed, MEDLINE, and Web of Sciences™ Core Collection to analyze the advantages and disadvantages of SC, IV, and IM administration in head-to-head comparative studies.Results“SC better than IV” involves trastuzumab, rituximab, antitumor necrosis factor medications, bortezomib, amifostine, recombinant human granulocyte-macrophage colony-stimulating factor, granulocyte colony-stimulating factor, recombinant interleukin-2, immunoglobulin, epoetin alfa, heparin, and opioids. “IV better than SC” involves ketamine, vitamin K1, and abatacept. With respect to insulin and ketamine, whether IV has advantages over SC is determined by specific clinical circumstances. “IM better than IV” involves epinephrine, hepatitis B immu-noglobulin, pegaspargase, and some antibiotics. “IV better than IM” involves ketamine, morphine, and antivenom. “IM better than SC” involves epinephrine. “SC better than IM” involves interferon-beta-1a, methotrexate, human chorionic gonadotropin, hepatitis B immunoglobulin, hydrocortisone, and morphine. Safety, efficacy, patient preference, and pharmacoeconomics are four principles governing the choice of injection route. Safety and efficacy must be the preferred principles to be considered (eg, epinephrine should be given intramuscularly during an episode of systemic anaphylaxis). If the safety and efficacy of two injection routes are equivalent, clinicians should consider more about patient preference and pharmacoeconomics because patient preference will ensure optimal treatment adherence and ultimately improve patient experience or satisfaction, while pharmacoeconomic concern will help alleviate nurse shortages and reduce overall health care costs. Besides the principles, the following detailed factors might affect the decision: patient characteristics-related factors (body mass index, age, sex, medical status [eg, renal impairment, comorbidities], personal attitudes toward safety and convenience, past experience, perception of current disease status, health literacy, and socioeconomic status), medication administration-related factors (anatomical site of injection, dose, frequency, formulation characteristics, administration time, indication, flexibility in the route of administration), and health care staff/institution-related factors (knowledge, human resources).ConclusionThis updated review of findings of comparative studies of different injection routes will enrich the knowledge of safe, efficacious, economic, and patient preference-oriented medication administration as well as...

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Section: Resultsmentioning

confidence: 99%

The optimal choice of medication administration route regarding intravenous, intramuscular, and subcutaneous injection

Jin¹,

Zhu²,

Chen³

et al. 2015

PPA

131

View full text Add to dashboard Cite

show abstract

“…From the results obtained, we concluded that XaraColl implanted intraoperatively was able to target and control visceral pain more efficiently than continuous perfusion of the surgical wound with bupivacaine for 72 hours postoperatively 10. Hence, XaraColl may be of particular benefit for reducing the postoperative pain normally experienced by patients undergoing laparoscopic surgery.…”

Section: Discussionmentioning

confidence: 93%

“…We have recently reported on the safety and efficacy of XaraColl, a bupivacaine-collagen implant, for postoperative analgesia in patients undergoing open inguinal hernioplasty9 and open gynecological surgery 10. From the results obtained, we concluded that XaraColl implanted intraoperatively was able to target and control visceral pain more efficiently than continuous perfusion of the surgical wound with bupivacaine for 72 hours postoperatively 10.…”

Section: Discussionmentioning

confidence: 99%

“…The product is implanted during surgery and releases bupivacaine for local, sustained action at the site(s) of surgical trauma, while maintaining low systemic levels well below the drug’s neurotoxicity and cardiotoxicity thresholds 8. Recently reported multicenter randomized controlled trials have suggested that XaraColl is safe and effective for reducing postoperative pain and/or patient need of opioid analgesics for up to 72 hours following a laparotomy procedure such as open hernioplasty9 or total abdominal hysterectomy 10. The primary aim of this study was to determine whether it was possible to implant and appropriately position XaraColl laparoscopically.…”

Section: Introductionmentioning

confidence: 99%

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A feasibility study to investigate the use of a bupivacaine-collagen implant (XaraColl) for postoperative analgesia following laparoscopic surgery

Hemsen¹,

Cusack²,

Minkowitz³

et al. 2013

JPR

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BackgroundXaraColl, a collagen-based implant that delivers bupivacaine to sites of surgical trauma, has been shown to reduce postoperative pain and use of opioid analgesia in patients undergoing open surgery. We therefore designed and conducted a preliminary feasibility study to investigate its application and ease of use for laparoscopic surgery.MethodsWe implanted four XaraColl implants each containing 50 mg of bupivacaine hydrochloride (200 mg total dose) in ten men undergoing laparoscopic inguinal or umbilical hernioplasty. Postoperative pain intensity and use of opioid analgesia were recorded through 72 hours for comparison with previously reported data from efficacy studies performed in men undergoing open inguinal hernioplasty. Safety was assessed for 30 days.ResultsXaraColl was easily and safely implanted via a laparoscope. The summed pain intensity and total use of opioid analgesia through the first 24 hours were similar to the values observed in previously reported studies for XaraColl-treated patients after open surgery, but were lower through 48 and 72 hours.ConclusionXaraColl is suitable for use in laparoscopic surgery and may provide postoperative analgesia in laparoscopic patients who often experience considerable postoperative pain in the first 24–48 hours following hospital discharge. Randomized controlled trials specifically to evaluate its efficacy in this application are warranted.

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“…In previous trials, preincision tramadol and ketamine injections were separately examined, but in this clinical trial, we used a low dosage combination of both (21, 22). …”

Section: Discussionmentioning

confidence: 99%

Combined Ketamine-Tramadol Subcutaneous Wound Infiltration for Multimodal Postoperative Analgesia: A Double-Blinded, Randomized Controlled Trial after Renal Surgery

et al. 2016

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BackgroundPain is an important consideration after renal surgery. A multimodal approach to postoperative pain management could enhance analgesia by risking fewer side effects after surgery.ObjectivesThe aim of this study was to evaluate the clinical efficacy of the subcutaneous infiltration of ketamine and tramadol at the incision site to reduce postoperative pain.MethodsSixty-four patients between 18 and 80 years old who were scheduled for elective renal surgery were enrolled in a double-blind randomized controlled study. At the end of the surgery, patients were divided into four groups with 16 patients in each group: the saline group, who were treated with 10 mL of saline solution; the K group, who were treated with 1 mg/kg etamine in 10 mL of saline solution; the T group, who were treated with 1 mg/kg tramadol in 10 mL of saline solution; and the K/T group, who were treated with 0.5 mg/kg ketamine with 0.5 mg/kg tramadol in 10 mL of saline solution. In each group, the solution was infiltrated subcutaneously at the incision site. The postoperative pain scores and rescue analgesic consumption of the patients in each group were recorded for 24 hours and compared. The primary goal of the study was to compare the results of patients treated with a combined ketamine and tramadol subcutaneous wound infiltration, patients treated with a tramadol subcutaneous wound infiltration, and patients treated with a ketamine subcutaneous wound infiltration.ResultsSixty-four patients were enrolled in the study. Pain intensity and cumulative meperidine consumption were significantly lower in the K/T group (27 mg; 95% confidence interval, 25.2 - 53.2) in comparison with the group that received a saline infusion during the first 24 hours after surgery (P < 0.001). The sedation score of the K, T, and K/T groups were significantly higher than the saline group (P < 0.001).ConclusionsThe combined subcutaneous infiltration of ketamine and tramadol at the incision site produces better analgesia and an opioid-sparing effect during the first 24 hours when compared with the control group and the groups that received a subcutaneous infiltration of only ketamine or tramadol.

show abstract

Preincisional administration of intravenous or subcutaneous infiltration of low-dose ketamine suppresses postoperative pain after appendectomy

Cited by 13 publications

References 25 publications

The optimal choice of medication administration route regarding intravenous, intramuscular, and subcutaneous injection

The optimal choice of medication administration route regarding intravenous, intramuscular, and subcutaneous injection

A feasibility study to investigate the use of a bupivacaine-collagen implant (XaraColl) for postoperative analgesia following laparoscopic surgery

Combined Ketamine-Tramadol Subcutaneous Wound Infiltration for Multimodal Postoperative Analgesia: A Double-Blinded, Randomized Controlled Trial after Renal Surgery

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