Canadian Journal of Anaesthesia

, Volume 43, Issue 3, pp 212–215 | Cite as

Comparison of morphine and morphine with ketamine for postoperative analgesia

  • Keith B. Javery
  • Todd W. Ussery
  • Herbert G. Steger
  • George W. Colclough
Reports of Investigation



The purpose of this study was to compare morphine with ketamine to morphine alone in a doubleblind investigation of postsurgical pain control.


Fortytwo ASA 1 and 2 patients undergoing elective microdiscectomy were administered either 1 mg · ml− 1 of morphine (n = 20) or 1 mg · ml− 1 of both morphine and ketamine (n = 22) via iv patient controlled analgesia (IVPCA). Pain relief and side effects were assessed at 24 hr after surgery.


The mean (SD) visual analogue scale (VAS) pain rating of 2.3 (1.67) for patients receiving morphine with ketamine was lower (P < 0.001) than the VAS scores of patients receiving only morphine 4.5 (1.54). Patients receiving morphine and ketamine also had less difficulty with side effects, reporting less nausea (P < 0.05), pruritus (P < 0.001), and urinary retention (P < 0.05). Although dysphoria is reported to be a common side effect of ketamine, complaints of dysphoria were rare in both groups, with only one subject (5%) in the morphine with ketamine group and three (15%) subjects receiving morphine alone reporting this side effect.


IVPCA ketamine in combination with morphine provides superior postsurgical pain relief at lower dosage and with fewer side effects than morphine alone.

Key words

analgesia: postoperative analgesics: ketamine, morphine surgery: orthopaedic 



Cette étude en double aveugle visait à comparer la kétamine associée à la morphine avec la morphine seule utilisée dans le but de traiter la douleur postopératoire.


Quarantedeux patients ASA 1 et 2 programmés pour une microdiscoïdectomie ont reçu 1 mg · ml− 1 de morphine (n = 10) ou 1 mg · ml− 1 à la fois de morphine et de kétamine iv (n = 22) par un dispositif d’analgésie autocontrôlée (PCAIV). Le soulagement et les effets secondaires ont été évalués 24 h après la chirurgie.


La moyenne (ET) de la valeur déterminée sur une échelle visuelle analogique (EVA) de 2,3 (1,67) pour les patients qui avaient reçu morphinekétamine était plus basse (P < 0,001) que celle des patients sous morphine 4,5 (1,54). Les patients sous morphinekétamine ont eu aussi moins d’effets secondaires dont moins de nausée (P < 0,05), de prurit (P < 0,001), et de rétention urinaire (P < 0,05). Bien que la dysphorie soit un effet secondaire fréquent de la kétamine, elle a été rarement rapportée dans les deux groupes, avec un seul sujet (5%) du groupe morphinekétamine et trois du groupe morphine seule (15%).


En PCAIV, la kétamine associée à la morphine procure une soulagement postopératoire de la douleur à des doses plus faibles et avec moins d’effets secondaires que la morphine seule.


  1. 1.
    Gross JB, Caldwell CB, Edwards MW. Induction doseresponse curves for midazolam and ketamine in premedicated ASA class III and IV patients. Anesth Analg 1985; 64: 795–800.PubMedGoogle Scholar
  2. 2.
    Amiot JF, Bouju P, Palacci JH, Balliner E. Intravenous regional anaesthesia with ketamine. Anaesthesia 1985; 40: 899–901.PubMedCrossRefGoogle Scholar
  3. 3.
    Kitahata LM, Taub A, Kosaka Y. Lamina-specific suppression of dorsal-horn unit activity by ketamine hydrochloride. Anesthesiology 1973; 38: 4–11.PubMedCrossRefGoogle Scholar
  4. 4.
    Dich-Nielsen JO, Svendsen LB, Berthelsen P. Intramuscular low-dose ketamine versus pethidine for postoperative pain treatment after thoracic surgery. Acta Anaesthesiol Scand 1992; 36: 583–7.PubMedGoogle Scholar
  5. 5.
    Hartvig P, Larsson E, Joachimsson PO. Postoperative analgesia and sedation following pediatric cardiac surgery using a constant infusion of ketamine. J Cardiothorac Vasc Anesth 1993; 7: 148–53.PubMedCrossRefGoogle Scholar
  6. 6.
    Pekoe GM, Smith DJ. The involvement of opiate and monoaminergic neuronal systems in the analgesic effects of ketamine. Pain 1982; 12: 57–73.PubMedCrossRefGoogle Scholar
  7. 7.
    Dowdy EG, Kaya K, Gocho Y. Some pharmacologie similarities of ketamine, lidocaine, and procaine. Anesth Analg 1973; 52: 839–42.PubMedCrossRefGoogle Scholar
  8. 8.
    Domino EF, Chodoff P, Corssen G. Pharmacologie effects of CI-581, a new dissociative anesthetic, in man. Clin Pharmacol Ther 1965; 6: 279–91.PubMedGoogle Scholar
  9. 9.
    Bourke DL, Malit LA, Smith TC. Respiratory interactions of ketamine and morphine. Anesthesiology 1987; 66: 153–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Reich DL, Silvay G. Ketamine: an update on the first twenty-five years of clinical experience. Can J Anaesth 1989; 36: 186–97.PubMedCrossRefGoogle Scholar
  11. 11.
    Corssen G, Guitierrez J, Reves JG, Huber FC Jr. Ketamine in the anesthetic management of asthmatic patients. Anesth Analg 1972; 51: 588–96.PubMedGoogle Scholar
  12. 12.
    Slogoff S, Allen GW. The role of baroreceptors in the cardiovascular response to ketamine. Anesth Analg 1974; 53: 704–7.PubMedGoogle Scholar
  13. 13.
    Leunt LY, Baillie TA. Comparative pharmacology in the rat of ketamine and its two principal metabolites, norketamine and (2)-6-hydroxynorketamine. J Med Chem 1986; 29: 2396–9.CrossRefGoogle Scholar
  14. 14.
    Bristow A, Orlikowski C. Subcutaneous ketamine analgesia: postoperative analgesia using subcutaneous infusions of ketamine and morphine. Ann R Coll Surg Engl 1989; 71:64–6.PubMedGoogle Scholar
  15. 15.
    Grant IS, Nimmo WS, McNicol LR, Clements JA. Ketamine disposition in children and adults. Br J Anaesth 1995; 55: 1107–11.CrossRefGoogle Scholar
  16. 16.
    White PF, Way WL, Trevor AJ. Ketamine — its pharmacology and therapeutic uses. Anesthesiology 1982; 56: 119–36.PubMedGoogle Scholar
  17. 17.
    Parkhause J, Mariott G. Postoperative analgesia with ketamine and pethidine. Anaesthesia 1977; 32: 285–9.CrossRefGoogle Scholar
  18. 18.
    Edwards ND, Fletcher A, Cole JR, Peacock JE. Combined infusions of morphine and ketamine for postoperative pain in elderly patients. Anaesthesia 1993; 48: 124–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Ferrente FM, Ostheimer GW, Covino BG. Patient characteristics influencing effective PCA,In: Ferrente FM, Ostheimer GW, Covino BG (Eds.). Patient Controlled Analgesia. Cambridge MA: Blackwell Scientific Publications: 1990: 51–60.Google Scholar
  20. 20.
    SPSS for Windows, Release 6.0. Chicago: SPSS, Inc. 1993.Google Scholar
  21. 21.
    Miyasaka M, Domino EF. Neural mechanisms of ketamine-induced anesthesia. Int J Neuropharmacol 1968; 7: 557–73.PubMedCrossRefGoogle Scholar
  22. 22.
    Corssen G, Reves JG, Stanley TH. Intravenous Anaesthesia and Analgesia. Philadelphia: Lea & Febiger, 1988.Google Scholar
  23. 23.
    Winters WD, Hance AJ, Cadd GG, Quam DD, Benthuysen JL. Ketamine- and morphine-induced analgesia and catalepsy. I. Tolerance, cross-tolerance, potentiation, residual morphine levels and naloxone action in the rat. J Pharmacol Exp Ther 1988; 244: 51–7.PubMedGoogle Scholar
  24. 24.
    Hance AJ, Winters WD, Quam DD, Benthuysen JL, Cadd GG. Catalepsy induced by combinations of ketamine and morphine: potentiation, antagonism, tolerance and cross tolerance in the rat. Neuropharmacology 1989; 28: 109–16.PubMedCrossRefGoogle Scholar
  25. 25.
    Fine J, Finestone SC. Sensory disturbances following ketamine anesthesia: recurrent hallucinations. Anesth Analg 1973; 52: 428–30.PubMedCrossRefGoogle Scholar
  26. 26.
    Sadove MS, Shulman M, Hatano S, Fevold N. Analgesic effects of ketamine administered in subdissociative doses. Anesth Analg 1971; 50: 452–7.PubMedGoogle Scholar

Copyright information

© Canadian Anesthesiologists 1996

Authors and Affiliations

  • Keith B. Javery
    • 1
  • Todd W. Ussery
    • 1
  • Herbert G. Steger
    • 1
  • George W. Colclough
    • 1
  1. 1.Department of AnesthesiologyUniversity of Kentucky Medical CenterLexingtonUSA

Personalised recommendations