Abstract
Purpose
The aim of this study was to assess the effect of pre- vs postincisional low-doseiv ketamine on postoperative pain in outpatients scheduled for oral surgery under general anesthesia.
Methods
Eighty-four patients were randomly assigned to receive intravenously saline before and after surgery in Group 1, ketamine 300 µg·kg-1 iv before and saline after surgery in Group 2, saline before and ketamine 300 µg·kg-1 iv after surgery in Group 3. Postoperative analgesia consisted ofiv proparacetamol and ketoprofen. Rescue analgesia consisted of nalbuphine 200 µg·kg-1 iv. Analgesia at home consisted of oral ketoprofen, and acetaminophen with codeine as rescue analgesia. A telephone interview was conducted on the first and second postoperative days.
Results
There were no significant differences between groups with respect to pain scores, the number of patients requiring nalbuphine in the postanesthesia care unit (PACU), (36.7%, 38.7%, and 39.5% for Groups 1, 2, and 3 respectively), or nalbuphine consumption in the PACU (66.5 µg·kg-1 ± 16.8, 75.9 µg·kg-1 ± 17.5, 66.7 µg·kg-1 ± 21.6 for Groups 1, 2, and 3 respectively). The number of rescue analgesic tablets taken at home, and time to first request for rescue analgesia, sedation scores, or side-effects were similar amongst groups. No patient required nalbuphine in the ambulatory care unit.
Conclusions
There was no benefit to pre-emptive administration of ketamine 300 µg·kg-1 iv whether administered pre- or postoperatively.
Résumé
Objectif
Le but de cette étude était de tester ľefficacité sur la douleur postopératoire de faibles doses iv de kétamine préopératoires vs postopératoires en chirurgie buccale ambulatoire.
Méthode
Quatre-vingt-quatre patients étaient répartis au hasard pour recevoir par voie iv respectivement avant et après la chirurgie: une solution salée dans le Groupe 1, 300 µg·kg-1 de kétamine et une solution salée dans le Groupe 2, une solution salée et 300 µg·kg-1 de kétamine dans le Groupe 3. Ľanalgésie postopératoire était assurée systématiquement par du propara-cétamol et du kétoprofène en hospitalisation, et du kétoprofène à domicile. ľanalgésie de complément était assurée par 200 µg·kg-1 de nalbuphine en hospitalisation, et par du paracétamol-codéine po à domicile. Un interview téléphonique était effectué les premier et second jours postopératoires.
Résultats
Aucune différence significative n’a été retrouvée entre les groupes concernant les scores de douleur, le nombre de patients ayant reçu de la nalbuphine (36,7 %, 38,7 %, et 39,5 % respectivement pour les Groupes 1, 2 et 3), la consommation de nalbuphine (66,5 µg·kg-1 ± 16,8, 75,9 µg·kg-1 ± 17,5, 66,7 µg·kg-1 ± 21,6 respectivement pour les Groupes 1, 2 et 3), le nombre de comprimés de secours à domicile: 6 (2,13), 7 (2,20), et 7 (1,12) respectivement pour les Groupes 1, 2 et 3, la première demande ďanalgésique de secours, les scores de sédation ou les effets secondaires.
Conclusion
Cette étude n’a démontré aucun effet préventif sur la douleur postopératoire de 300 µg·kg-1 de kétamine iv administrée avant ou après ľopération.
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Lebrun, T., Elstraete, A.C., Sandefo, I. et al. Lack of a pre-emptive effect of low-dose ketamine on postoperative pain following oral surgery. Can J Anesth 53, 146–152 (2006). https://doi.org/10.1007/BF03021819
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DOI: https://doi.org/10.1007/BF03021819