Canadian Journal of Anaesthesia

, Volume 45, Issue 2, pp 103–109 | Cite as

Epidural ketamine reduces post-operative epidural PCA consumption of fentanyl/bupivacaine

  • M. E. Abdel-Ghaffar
  • M. Abdulatif
  • A. Al-Ghamdi
  • H. Mowafi
  • A. Anwar
Reports of Investigation

Abstract

Purpose

To study the analgesic effect of epidural ketamine on postoperative pan and epidural PCA consumption after total abdominal hysterectomy.

Methods

Sixty-one ASA I–II patients, 34–60 yr were randomly assigned into three groups. Epidural catheters were inserted before induction of anaesthesia. Patients in group I and II received 30 mg ketamine epidurally before induction of anaesthesia or 20 min after skin incision: group III received placebo, Postoperatively, on first analgesia request, sedation score, Visual Analogue Scale (VAS), Prince Henry Score (PHS) and Bromage motor weakness score were taken and followed by an epidural bolus of 9 ml bupivacaine 0.25% + 50 μg fentanyl. Analgesia was maintained by PCA with a mixture of bupivacaine 0.1% + fentanyl 0.001% epidurally. Measurements were repeated at 1, 2, 4, 8, 12 and 24 hr.

Results

First analgesia request was 17 ±6.8 min in the control group compared with 31.4 ±23.8 and 44 ±23.1 min for groups I and II respectively. The differences between group III and group I (P < 0.05) and between group III and group II (P < 0,01) were statistically significant. Twenty four hour PCA consumption was 101.2 ±47.2, 87 ±27 and 162 ±38 ml for groups I, II and III respectively. The differences between group III and group I and that between group III and group II were statistically significant (P < 0.001 ).

Conclusion

Epidural ketamine 30 mg reduces post hysterectomy pain as evidenced by prolongation of time to first analgesia request and reduction in postoperative epidural PCA consumption. This effect is manifest whether ketamine is given before induction or 20 min after skin incision.

Résumé

Objectif

Étudier l’effet analgésique de l’administration péridurale de kétamine sur la douleur post-opératoire et la consommation d’analgésique par ACP péridurale après hystérectomie abdominale totale.

Méthodes

61 patientes, ASA I et II, âgées de 34 à 60 ans ont été attribuées au hasard à trois groupes. Les cathéters périduraux ont été installés avant l’induction de l’anesthésie. Les patientes des groupes I et II ont reçu 30 mg de kétamine par voie péridurale avant l’induction ou 20 minutes après l’incision cutanée, alors que le groupe III recevait un placebo. Après l’opération, lors de la première demande d’analgésie, on a enregistré le score de sédation, l’échelle visuelle analogue (EVA), le score Prince Henry (PHS) et le score de faiblesse motrice de Bromage pour ensute administrer un bolus péridural de 9 ml de bupivacaïne 0,25% + 50 mcg de fentanyl. L’analgésie a été maintenue par ACP péridurale avec une solution de bupivacaïne 0,1% + fentanyl 0,001%. Les mesures ont été répétées à 1, 2, 4, 8, 12 et 24 heures.

Résultats

La première demande d’analgésie est survenue à 17 ±6,8 min dans le groupe contrôle et à 31,4 ±23,8 min et 44 ±23,1 min pour les groupes I et II respectivement. Les différences entre le groupe III et le groupe I (P < 0,05) et entre le groupe III et le groupe II (P < 0,01 ) sont statistiquement significatives. La consommation de 24 heures de solution analgésique épidurale a été de 101,2 ±47,2, 87 ±27 et 162 ±38 ml pour les groupes I, II et III respectivement. Les différences entre le groupe III et les groupes I et II étaient statistiquement significatives (P < 0,001).

Conclusion

La kétamine 30 mg administrée par voie péridurale réduit la douleur post hystérectomie tel que démontré par une prolongation de la période précédant la première demande d’analgésie et par la réduciton de l’utilisation de l’ACP péridurale. Cet effet existe, que la kétamine soit donnée avant l’induction ou 20 minutes après l’incision cutanée.

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Copyright information

© Canadian Anaesthesiologists 1998

Authors and Affiliations

  • M. E. Abdel-Ghaffar
    • 1
  • M. Abdulatif
    • 2
  • A. Al-Ghamdi
    • 3
  • H. Mowafi
    • 3
  • A. Anwar
    • 3
  1. 1.Anesthesiology DepartmentKing Fahd Hospital of the UniversityAl-KhobarSaudi Arabia
  2. 2.Cairo UniversityEgypt
  3. 3.King Faisal UniversitySaudi Arabia

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