الملخص
Background: The multimodal approach to postoperative pain management is the current trend of achieving adequate postoperative analgesia with minimal or no side effects of analgesic drugs. We sought to determine the effect of continuous intra-operative infusion of low–dose ketamine on post-operative analgesia following
mastectomy.
Methods: The study was a prospective, double blind, randomized controlled study. The patients were randomized into either: (a) FK group, which received intravenous continuous infusion of 2 µg/kg/hr of fentanyl + 0.5 mg/kg/hr of ketamine. Or (b) FN group, which received intravenous continuous infusion of 2 µg/kg/hr of fentanyl and normal saline. The primary outcome was time to first request for analgesia after surgery. Secondary outcomes were pain scores in the first twenty-four hours, postoperative analgesic consumption and overall satisfaction with pain control.
Results: The time to first request for analgesia was longer in the ketamine group 245.61± 160.46 minutes versus 179.42 ± 161.46 minutes in the control group (p=0.0217). The median NRS in the first 6 hours showed no significant difference. The cumulative postoperative tramadol consumption in the ketamine group was lower than that recorded for the control group (162.73±60.43mg versus 182.95±63.27mg). The satisfaction with overall pain control was better in the ketamine group (p=0.030).
Conclusion: The administration of intraoperative low dose ketamine infusion with fentanyl to patients during mastectomy enhances postoperative analgesia and overall satisfaction with pain control. It reduces postoperative analgesic requirement in the immediate postoperative period with minimal side effect.
Keywords: Postoperative pain; multimodal analgesia; ketamine; mastectomy
Résumé
Contexte: L’approche multimodale de la gestion de la douleur postopératoire est la tendance actuelle à obtenir une analgésie postopératoire adéquate avec des effets secondaires minimes ou inexistants des analgésiques. Nous avons cherché à déterminer l’effet de la perfusion intraopératoire continue de kétamine à faible dose sur l’analgésie postopératoire après mastectomie.
Méthodes: L’étude était une étude prospective, double aveugle, randomisée et contrôlée. Les patients ont été randomisés dans l’un ou l’autre: (a) groupe FK, qui a reçu une perfusion intraveineuse continue de 2 µg / kg / h de fentanyl + 0,5 mg / kg / h de kétamine. Ou (b) groupe FN, qui a reçu une perfusion intraveineuse continue de 2 µg / kg / h de fentanyl et de solution saline normale. Le critère de jugement principal était le moment de la première demande d’analgésie après la chirurgie. Les critères de jugement secondaires étaient les scores de douleur au cours des vingt-quatre premières heures, la consommation d’analgésiques postopératoires et la satisfaction globale à l’égard du contrôle de la douleur.
Résultats: Le temps à la première demande d’analgésie était plus long dans le groupe kétamine 245,61 ± 160,46 minutes contre 179,42 ± 161,46 minutes dans le groupe témoin (p = 0,0217). NRS médian au cours des 6 premières heures n’a montré aucune différence significative. La consommation cumulée de tramadol postopératoire dans le groupe kétamine était inférieure à celle enregistrée pour le groupe témoin (162,73 ± 60,43 mg contre 182,95 ± 63,27 mg). La satisfaction à l’égard du contrôle global de la douleur était meilleure dans le groupe kétamine (p = 0,030).
Conclusion: L’administration d’une perfusion peropératoire de kétamine à faible dose avec du fentanyl chez des patients pendant une mastectomie améliore l’analgésie postopératoire et la satisfaction globale du contrôle de la douleur. Elle réduit les besoins analgésiques postopératoires dans la période postopératoire immédiate avec un effet secondaire minimal.
Mots clés: douleur postopératoire; analgésie multimodale; la kétamine; mastectomie
Correspondence: Dr. Osinaike, Babatunde Babasola, Department of Anaesthesia, University College Hospital, PMB 5116, Ibadan. Mobile - +234-80-33303675; Email- drosinaike@yahoo.co.uk
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