Safety of mixture of morphine with ketamine for postoperative patient‐controlled analgesia: an audit with 1026 patients

Abstract

Patient-controlled analgesia with morphine and ketamine is safe. It produces side-effects which, however, are infrequently a reason for discontinuing the regimen. It is also associated with low pain scores and high patient satisfaction.

Post-Operative Analgesia in Patients Undergoing Major Surgeries: Effect of Adding Iv Ketamine to Morphine in Presence of Morphine Resistant Pain

“…15,16 Animal and clinical studies demonstrate that acute opioid tolerance can be prevented by co administration of NMDA receptor antaogonist 9,17 as shown in our study by adding just 250 µg/kg of ketamine to 15 µg/kg of morphine in postoperative patients. Weinbroum et al (2003) 17 found that subjectively evaluated pain in intensity during the 2 hour PACU stay was significantly lower for MK patients as compared to their MS counterparts despite large amounts of morphine administered.…”

Oral Ketamine for the Treatment of Type I Complex Regional Pain Syndrome

“…[14][15][16][17][18][19][20][21][22]24 This, and the fact that the same analgesic effect can be achieved with lower doses (up to 30% to 40% lower) using this same administration route-thereby contributing to a lessening of side effects as compared with the parenteral route 21 -led us to apply this management protocol to our patient.…”

“…13 On the other hand, the drug has also been shown to be very effective in patients with severe neuropathic pain secondary to other causes: oncological pain, 14 pain of central origin secondary to stroke, 15 chronic neuropathic pain of spinal origin, 16 postherpetic neuralgia, 17 phan- 21 and postoperative pain. 22 However, we have found no reference in the literature of the clinical use of oral ketamine in patients with CRPS. The most frequent adverse effects of ketamine involve the central nervous system, and include cognitive dysfunction, dizziness, visual hallucinations, nightmares, and even pseudo-psychiatric disorders 15 though none of these problems was recorded in our case.…”

The use of dextroketamine as postoperative adjuvant analgesia in a patient undergoing thoracotomy. Case report

“…Some authors have shown that low dextroketamine doses associated to morphine potentiate analgesia and decrease opioids adverse effects, as well as its ability to decrease pain scores 9 . A large prospective study has shown safety of intravenous dextroketamine and morphine for patient--controlled analgesia 10 . In a systematic review of ketamine for postoperative analgesia, authors have concluded that intravenous ketamine is an effective adjuvant, decreases opioid consumption, improves pain control quality, with special benefits for more painful procedures, such as high abdominal surgeries, thoracotomies and major orthopedic interventions 11 .…”