Amr Samir WAHDAN
(Cairo University, Faculty of Medicine, Department of Anaesthesia Surgical ICU and Pain Management, Cairo, Egypt)
Mennattah Magdi MOHAMED
(Cairo University, Faculty of Medicine, Department of Anaesthesia Surgical ICU and Pain Management, Cairo, Egypt)
Nadia YOUSEF HELMY
(Cairo University, Faculty of Medicine, Department of Anaesthesia Surgical ICU and Pain Management, Cairo, Egypt)
Gehan HELMY SHEHATA
(Cairo University, Faculty of Medicine, Department of Anaesthesia Surgical ICU and Pain Management, Cairo, Egypt)
Atef Kamal SALAMA
(Cairo University, Faculty of Medicine, Department of Anaesthesia Surgical ICU and Pain Management, Cairo, Egypt)
Yıl: 2021Cilt: 49Sayı: 1ISSN: 2667-677X / 2667-6370Sayfa Aralığı: 52 - 57İngilizce

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Effects of Low-Dose Ketamine Infusion on Alleviating the Opioid Burden for Patients Undergoing Myomectomy Surgery
Objective: Recent research has focused on the use of N-methyl-D-aspartate (NMDA) receptor antagonists for pain management. Several drugs are known to have this action, including ketamine, which exerts its main analgesic effect through NMDA receptor antagonism. This study aimed to evaluate the effect of low-dose ketamine infusion on opioid exposure for patients undergoing myomectomy surgery under general anaesthesia.Methods: A total of 70 women were included in this prospective double-blind trial study. The patients included in this study were American Society of Anaesthesiologists physical status I–II, aged between 18 and 50 years and scheduled for laparotomy myomectomy surgery. Patients were randomised to receive either a bolus of 0.2 mg kg-1 of ketamine followed by a continuous infusion of 0.2 mg kg-1 hr-1 during the operation or a placebo of normal saline. Both groups also received morphine as needed for pain relief. The primary outcome was the total amount of morphine used during the intraoperative and postoperative periods. Intraoperative and postoperative mean blood pressure, heart rate and postoperative visual analogue scale for pain were assessed.Results: Total mean morphine consumption was significantly lower in the ketamine group than in the control group (26±3.5 mg vs. 34.7±3.3 mg, respectively, p<0.05). However, there were no statistical differences between the groups regarding haemodynamics, postoperative pain score and complications.Conclusion: The use of ketamine in low infusion doses intraoperatively during an elective myomectomy procedure produced an opioid-sparing effect by reducing perioperative morphine consumption without significant side effects.
DergiAraştırma MakalesiErişime Açık
  • 1. Sami Walid M, Heaton RL. The role of laparoscopic myomectomy in the management of uterine fibroids. Curr Opin Obstet Gynecol 2011; 23: 273-7. [Crossref]
  • 2. Christina C. Postoperative Pain Control. Clinic Colon Rectal Surg 2013; 26: 191-6. [Crossref]
  • 3. Brennan F, Carr DB, Cousins M. Pain management: a fundamental human right. Anesthesia Analgesia 2007; 106: 205-21. [Crossref]
  • 4. Wall PD, Melzack R. Pain measurements in persons in pain. In: Wall PD, Melzack R, editors. Textbook of pain. 4th ed. Edinburgh: Churchill Livingstone; 1999, p. 409-26.
  • 5. Katz N, Mazer NA. The impact of opioids on the endocrine system. Clin J Pain 2009; 25: 170-5. [Crossref]
  • 6. Snijdelaar DG, Cornelisse HB, Schmid RL, Katz J. A randomised, controlled study of peri-operative low dose s(+)-ketamine in combination with postoperative patient-controlled s(+)-ketamine and morphine after radical prostatectomy. Anesthesia 2004; 59: 222-8. [Crossref]
  • 7. Gu X, Wu X, Liu Y, Cui S, Ma Z. Tyrosine phosphorylation of the N-Methyl-D-Aspartate receptor 2B subunit in spinal cord contributes to remifentanil-induced postoperative hyperalgesia: the preventive effect of ketamine. Mol Pain 2009; 5: 76. [Crossref]
  • 8. Minville V, Fourcade O, Girolami JP, Tack I. Opioid-induced hyperalgesia in a mice model of orthopaedic pain: preventive effect of ketamine. Br J Anaesth 2010; 104: 231-8. [Crossref]
  • 9. Liu Y, Zheng Y, Gu X, Ma Z. The efficacy of NMDA receptor antagonists for preventing remifentanil‐induced increase in postoperative pain and analgesia requirement: a meta‐analysis. Minerva Anestesiol 2012; 78: 653-67.
  • 10. Dahmani S, Michelet D, Abback PS, Wood C, Brasher C, Nivoche Y, et al. Ketamine for perioperative pain management in children: a meta-analysis of published studies. Paediatr Anaesth 2011; 21: 636-52. [Crossref]
  • 11. Elia N, Tramèr MR. Ketamine and postoperative pain-a quantitative systematic review of randomised trials. Pain 2005; 113: 61-70. [Crossref]
  • 12. Snijdelaar DG, Cornelisse HB, Schmid RL, Katz J. A randomised, controlled study of peri-operative low dose s(+)-ketamine in combination with postoperative patient-controlled s(+)-ketamine and morphine after radical prostatectomy. Anaesthesia 2004; 59: 222-8. [Crossref]
  • 13. Woolf CJ, Thompson SW. The induction and maintenance of central sensitization is dependent on N-methyl-Daspartic acid receptor activation; implications for the treatment of post-injury pain hypersensitivity states. Pain 1991; 44: 293-9. [Crossref]
  • 14. Niesters M, Khalili-Mahani N, Martini C, Aarts L, van Gerven J, van Buchem MA, et al. Effect of subanesthetic ketamine on intrinsic functional brain connectivity: a placebo-controlled functional magnetic resonance imaging study in healthy male volunteers, Anesthesiology 2012; 117: 868-77. [Crossref]
  • 15. Pacheco Dda F, Romero TR, Duarte ID. Central antinociception induced by ketamine is mediated by endogenous opioids and - And -opioid receptors. Brain Res 2014; 1562: 69-75. [Crossref]
  • 16. Kim SH, Kim SI, Ok SY, Park SY, Kim MG, Lee SJ, et al. Opioid sparing effect of low dose ketamine in patients with intravenous patient-controlled analgesia using fentanyl after lumbar spinal fusion surgery, Korean J Anesthesiol 2013; 64: 524-8. [Crossref]
  • 17. Cengiz P, Gokcinar D, Karabeyoglu I, Topcu H, Cicek GS, Gogus N. Intraoperative low-dose ketamine infusion reduces acute postoperative pain following total knee replacement surgery: a prospective, randomized double-blind placebo-controlled trial. J Coll Physicians Surg Pak 2014; 24: 299-303.
  • 18. Goswami D, Nisa N, Sharma A, Dadhwal V, Baidya DK, Arora M. Low-Dose Ketamine for Outpatient Hysteroscopy: A Prospective, Randomised, Double-Blind Study. Turk J Anaesthesiol Reanim 2021; 48: 134-41. [Crossref]
  • 19. Ilkjaer S, Nikolajsen L, Hansen TM, Wernberg M, Brennum J, Dahl JB. Effect of IV ketamine in combination with epidural bupivacaine or epidural morphine on postoperative pain and wound tenderness after renal surgery. Br J Anaesth 1998; 81: 707-12. [Crossref]
  • 20. Biçer F, Eti Z, Saraçoğlu KT, Altun K, Göğüş FY. Does the method and timing of intravenous ketamine administration affect postoperative morphine requirement after major abdominal surgery? Turk J Anaesthesiol Reanim 2014; 42: 320-5. [Crossref]
  • 21. Anis NA, Berry SC, Burton NR, Lodge D. The dissociative anaesthetics, ketamine and phencyclidine, selectively reduce excitation of central mammalian neurones by N-methyl-aspartate. Br J Pharmacol 1983; 79: 565-75. [Crossref]
  • 22. Katalinic N, Lai R, Somogyi A, Mitchell PB, Glue P, Loo KC. Ketamine as a new treatment for depression: a review of its efficacy and adverse effects. Aust N Z J Psychiatry 2013; 47: 710-27. [Crossref]
  • 23. Hadi BA, Daas R, Zelko R. A randomized controlled trial of a clinical pharmacist intervention in microdiscectomy surgery-low dose intravenous ketamine as an adjunct to standard therapy. Saudi Pharm J 2013; 21: 169-75. [Crossref]

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