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J Clin Anesth. 2005 Dec;17(8):592-7.

The influence of timing of systemic ketamine administration on postoperative morphine consumption.

Author information

  • 1Department of Anesthesiology, Faculty of Medicine, Uludağ University, Bursa 16059, Turkey. hbilgin@uludag.edu.tr

Abstract

STUDY OBJECTIVE:

To determine the influence of timing of systemic ketamine administration on postoperative morphine consumption.

DESIGN:

Prospective randomized study.

SETTING:

Operating rooms, postanesthesia care unit, and gynecology service of a university hospital.

PATIENTS:

Forty-five patients undergoing laparotomy for benign gynecologic pathologies were randomized into 3 groups.

INTERVENTIONS:

In Group 1, before surgical incision, patients received 0.5 mg/kg ketamine IV, followed by normal saline infusion and normal saline IV at wound closure in group 1 (n = 15). In group 2 (n = 15), patients received 0.5 mg/kg ketamine IV before surgery, followed by ketamine infusion 600 mug . kg(-1) . h(-1), until wound closure and normal saline IV at that time. In the other group (group 3, n = 15), patients received normal saline IV before surgery, followed by saline infusion and then 0.5 mg/kg ketamine IV at wound closure. In the postoperative period, patient-controlled analgesia IV morphine was used for postoperative pain relief. First requested analgesic medication time was recorded. Postoperative pain was assessed by measuring morphine consumption at 0 to 2, 0 to 4, and 0 to 24 hours and visual analog scale (VAS) pain scores in response to cough at 2nd, 4th, and 24th hours and during rest at 0 to 2, 0 to 4, and 0 to 24 hours after surgery.

MEASUREMENT AND MAIN RESULTS:

First requested analgesia was shorter in group 1 than the others (P < .01). Mean VAS pain scores in response to cough at 24th hour in groups 2 and 3 were significantly lower than in group 1 (P < .001 and P < .01, respectively). Mean VAS pain scores during rest at 0 to 24 hours in groups 2 and 3 were significantly lower than in group 1 (P < .01 and P < .05, respectively). Morphine consumption was lower in groups 2 and 3 at 0 to 2 hours (P < .001 and P < .01). Moreover, morphine consumption at 0 to 4 hours in group 2 was significantly lower (P < .01).

CONCLUSIONS:

Lower pain scores and morphine consumption in groups 2 and 3 may be related to higher plasma ketamine concentrations caused by the higher doses and later administration. Our findings suggest that a single preoperative dose of ketamine provided less analgesia compared with other dosing regimens that included intraoperative infusions or postoperative administration.

PMID:
16427528
[PubMed - indexed for MEDLINE]
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