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

Kim, Dong Ho; Choi, June Young; Kim, Byoung Gook; Hwang, Jin Young; Park, Seong Joo; Oh, Ah Young; Jeon, Young Tae; Ryu, Jung Hee

doi:10.1097/md.0000000000005485

Cited by 13 publications

(19 citation statements)

References 22 publications

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“… 5 Patients undergoing RoT often complain of moderate to severe pain especially at 0, 1, and 6 h postoperatively. 5 , 17 In the present study, the median pain score in the control group at 6 h postoperatively was 4 (IQR: 3), which is consistent with other studies of the BABA approach. 4 , 5 , 17 Highly severe pain needs to be managed properly to decrease morbidity and increase quality of life.…”

Section: Discussionsupporting

confidence: 91%

“… 5 , 17 In the present study, the median pain score in the control group at 6 h postoperatively was 4 (IQR: 3), which is consistent with other studies of the BABA approach. 4 , 5 , 17 Highly severe pain needs to be managed properly to decrease morbidity and increase quality of life. In the present study, patients in the ketamine group had VAS scores consistent with only mild pain at 6 h postoperatively, which was the primary endpoint of this investigation.…”

Section: Discussionsupporting

confidence: 91%

“… 12 , 44 Our ketamine dosage is also in line with that in previous investigations regarding low-dose ketamine infusion during surgery for postoperative pain. 12 , 42 Our ketamine infusion protocol decreased the patients’ acute postoperative pain scores in the anterior chest area, while the infusion protocol in the study by Kim et al 17 did not. The more stable plasma concentration of ketamine during surgery may have been associated with the prevention of acute postoperative pain in the chest area in this study.…”

Section: Discussionmentioning

confidence: 67%

“…A previous study by Kim et al 17 demonstrated the efficacy of ketamine on postoperative pain after robotic or endoscopic thyroidectomy. Our study showed similar results with respect to the reduction in acute pain provided by ketamine.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of ketamine for postoperative pain following robotic thyroidectomy: A prospective randomised study

et al. 2017

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ObjectiveAlthough robotic thyroidectomy (RoT) is a minimally invasive surgery, percutaneous tunneling causes moderate to severe pain immediately postoperatively. We evaluated the efficacy of ketamine for postoperative pain management in patients following RoT.MethodsSixty-four patients scheduled for RoT were randomly divided into two groups. In the ketamine group (n = 32), ketamine was infused from induction of anaesthesia until the end of the procedure (0.15-mg/kg bolus with continuous infusion at 2 µg/kg/min). In the control group (n = 32), the same volume of saline was infused. Visual analogue scale (VAS) scores for acute and chronic pain, the incidence of hypoesthesia, postoperative analgesic requirements, and complications related to opioids or ketamine were compared between the two groups.ResultsThe VAS pain scores were significantly lower in the ketamine group up to 24 h postoperatively. The VAS pain score when coughing was significantly higher in the control group than in the ketamine group at 24 h postoperatively. A significantly greater proportion of patients in the control group required rescue analgesics. Complications were comparable in both groups.ConclusionsKetamine infusion decreased pain scores for 24 h postoperatively and reduced analgesic requirements without serious complications in patients following RoT.Trial Registration: Clinicaltrials.gov Identifier: NCT01997801

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Efficacy of ketamine for postoperative pain following robotic thyroidectomy: A prospective randomised study

et al. 2017

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“…Presently, although a variety of treatments are available for neck pain relief of CS, such as nonsteroidal anti-inflammatory drugs, [ 17 ] physiotherapy, [ 18 , 19 ] analgesics, [ 20 , 21 ] among others, those therapies have limited efficacy in relieving neck pain and many of them are associated with cumbersome side effects. It has been reported that alternative medicine, such as acupuncture, [ 22 ] neck exercise, [ 18 , 23 ] percutaneous neuromuscular electrical stimulation (PNMES), [ 24 ] herbal medication, [ 25 ] and so on, has been widely used to treat neck pain of CS, and with few adverse events (AEs), or even without AEs.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of percutaneous neuromuscular electrical stimulation for neck pain relief in patients with cervical spondylosis

Miao

Qiang

Jin³

2018

Medicine

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Background:This study aimed to evaluate the effectiveness and safety of percutaneous neuromuscular electrical stimulation (PNMES) for treating neck pain in patients with cervical spondylosis (CS).Methods:One hundred and twenty four patients with neck pain of CS were included, and then they were randomly divided into a PNMES group and a control group in a ratio of 1:1. All patients received PNMES or sham PNMES 30 minutes daily, 3 times weekly for 12 weeks. The primary outcome was assessed by the visual analog scale (VAS). The secondary outcomes were evaluated by the cervical range of motion (ROM), neck disability index (NDI) score, as well as the adverse events (AEs). All outcome measurements were measured at the end of 12-week treatment, and 4-week follow-up after treatment.Results:At the end of the 12-week treatment, and 4-week follow-up, the patients receiving PNMES exhibited more decrease in the mean VAS (P < .01), and NDI (P < .01) respectively, compared with the patients receiving sham PNMES. Additionally, the increase in the mean ROM was also significantly higher in the PNMES group than that in the sham PNMES group at the end of the 12-week treatment, and 4-week follow-up, respectively (P < .01). No AEs were found in either group.Conclusions:The results of this study demonstrated that PNMES is more effective than Sham PNMES for neck pain relief in patients with CS.

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

Cited by 13 publications

References 22 publications

Efficacy of ketamine for postoperative pain following robotic thyroidectomy: A prospective randomised study

Efficacy of ketamine for postoperative pain following robotic thyroidectomy: A prospective randomised study

Effectiveness of percutaneous neuromuscular electrical stimulation for neck pain relief in patients with cervical spondylosis

Perioperative intravenous ketamine for acute postoperative pain in adults

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