Preemptive Use of Ketamine on Post Operative Pain of Appendectomy

Medical University of Isfahan, Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran.
The Korean journal of pain 09/2011; 24(3):137-40. DOI: 10.3344/kjp.2011.24.3.137
Source: PubMed


Although early reviews of clinical findings were mostly negative, there is still a widespread belief for the efficacy of preemptive analgesia among clinicians. In this study, we evaluated whether the preemptive use of ketamine decreases post operative pain in patients undergoing appendectomy.
In double-blind, randomized clinical trials, 80 adult male patients undergoing an operation for acute appendicitis were studied. Patients were randomly assigned to two groups. In the operating room, patients in the ketamine group received 0.5 mg/kg of ketamine IV 10 minutes before the surgical incision. In the control group, 0.5 mg/kg of normal saline was injected. The pain intensity was assessed at time 0 (immediately after arousal) and 4, 12, and 24 hours postoperatively using the 10 points visual analogue scale (VAS).
Eighty patients (40 for both groups) were enrolled in this study. For all of the evaluated times, the VAS score was significantly lower in the ketamine group compared to the control. The interval time for the first analgesic request was 23.1 ± 6.7 minutes for the case group and 18.1 ± 7.3 minutes for the control (P = 0.02). The total number of pethidine injections in the first 24 hours postoperatively was 0.6 ± 0.6 for the case group and 2.0 ± 0.8 for the controls (P = 0.032). There were no drug side effects for the case group.
A low dose of intravenously administered ketamine had a preemptive effect in reducing pain after appendectomy.

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    • "They explained that this was because when a high dose of ketamine is administered, it can reach a relatively higher plasma concentration to suppress NMDA-R activation compared to that of low-dose administration. However, there are other reports in which 0.5 mg/kg of ketamine was helpful for relieving postoperative pain after abdominal surgery [18,19], and even that the analgesic requirement after cesarean section was reduced with administration of a low dose of 0.15 mg/kg [10,11]. There is also a report that the morphine requirement was not different in three groups of cesarean section patients administered 0.25, 0.5, or 1.0 mg/kg of ketamine [20]; thus, it is possible that the preemptive analgesic effect of ketamine is not dose dependent. "
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    ABSTRACT: Ketamine, an N-methyl-D-aspartate receptor antagonist, might play a role in postoperative analgesia, but its effect on postoperative pain after caesarean section varies with study design. We investigated whether the preemptive administration of low-dose intravenous ketamine decreases postoperative opioid requirement and postoperative pain in parturients receiving intravenous fentanyl with patient-controlled analgesia (PCA) following caesarean section. Spinal anesthesia was performed in 40 parturients scheduled for elective caesarean section. Patients in the ketamine group received a 0.5 mg/kg ketamine bolus intravenously followed by 0.25 mg/kg/h continuous infusion during the operation. The control group received the same volume of normal saline. Immediately after surgery, the patients were connected to a PCA device set to deliver 25-µg fentanyl as an intravenous bolus with a 15-min lockout interval and no continuous dose. Postoperative pain was assessed using the cumulative dose of fentanyl and visual analog scale (VAS) scores at 2, 6, 24, and 48 h postoperatively. Significantly less fentanyl was used in the ketamine group 2 h after surgery (P = 0.033), but the difference was not significant at 6, 12, and 24 h postoperatively. No significant differences were observed between the VAS scores of the two groups at 2, 6, 12, and 24 h postoperatively. Intraoperative low-dose ketamine did not have a preemptive analgesic effect and was not effective as an adjuvant to decrease opioid requirement or postoperative pain score in parturients receiving intravenous PCA with fentanyl after caesarean section.
    The Korean journal of pain 07/2013; 26(3):270-6. DOI:10.3344/kjp.2013.26.3.270
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    ABSTRACT: Backgrounds: In childhood, the most performed emergency abdominal operation is appendectomy. In this study, we aimed to evaluate a combination of levobupivacaine and morphine via caudal route in the management of postoperative pain after open appendectomy in children. Methods: A total of 120 children with ASA I-II physical status, aged 3-7 years and undergoing open appendectomy, were randomly allocated to two groups; only 0.5% levobupivacaine 1.5 mL/kg (Group L) and 0.5% levobupivacaine 1.5 mL/kg plus morphine 50μg/kg (Group LM). After the surgery, pain management was quantified with Modified Eastern Ontario Children's Hospital pain scale (mCHEOPS) up to 24 hours postoperatively Side effects of the procedure and test drugs were also recorded. Results: A total of 102 patients aged between 3-7 years, belonging to ASA I-IIE category were included in the study. The two groups were comparable for demographic data. On comparison of postoperative pain scores, Group L had significantly higher pain scores at 1, 2 and 3 hours postoperatively compared to Group LM (p<0.05). Conclusion: In children undergoing open appendectomy, single-dose levobupivacaine + morphine mixture via caudal route is a simple, safe and efficient method for post-operative analgesia.
    Journal of Anesthesia & Clinical Research 05/2012; 2012(1). DOI:10.4172/2155-6148.1000278 · 1.40 Impact Factor
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    ABSTRACT: Objective: Low-dose ketamine (LDK) may be useful for treatment for opioid-tolerant patients. We conducted a survey of patients and their treating clinicians regarding LDK for analgesia. Methods: Survey data included the following: vital signs and pain score before and after LDK, demographics, and adverse effects. Treating physicians were queried about reasons for use of LDK and overall satisfaction. Results: Twenty-four patients were enrolled: 21 received LDK for analgesia, and 3 received LDK for sedation. Pain level on a visual analog scale (range, 1-10) after LDK was significantly decreased from 8.9 ± 2.1 to 3.9 ± 3.4 (P < .0001). Change in vital signs after administration of LDK was not statistically significant. Overall patient satisfaction with LDK was 55%, and overall physician satisfaction was 72%. Sixteen (67%) of patients would prefer LDK again, and 23 (96%) of physicians would use LDK again for analgesia. Four patients reported an adverse experience, but there were no emergence reactions. Race subanalysis revealed no difference in pain reduction, but whites were least satisfied compared with black and Hispanic patients (P = .02). Physician reasons for using LDK included opioid failure (88%), concern for respiratory depression (17%), concern for multiple opioid allergies (13%), and concern for hypotension (8%). Most (96%) physicians believed that LDK is underused. Conclusion: Low-dose ketamine may decrease patients' perception of pain. Most were satisfied with LDK for this purpose and would use it again. Whites were least satisfied with the use of LDK for analgesia. Physicians believed that ketamine is underused.
    The American journal of emergency medicine 10/2012; 31(2). DOI:10.1016/j.ajem.2012.07.027 · 1.27 Impact Factor
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