Keywords : KETAMINE
EFFICACY OF PREEMPTIVE PREINCISIONAL USE OF KETAMINE ON POSTOPERATIVE PAIN RELIEF FOLLOWING APPENDECTOMY
Basrah Journal of Surgery,
2015, Volume 21, Issue 1, Pages 18-23
Pain, which is often inadequately treated, accompanies the surgical procedures may persist long after tissue healing. Preemptive analgesia, involves the introduction of an analgesic regimen before the onset of noxious stimuli. Previous studies have suggested that ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, provides a preemptive analgesic effect. In literature, its use is controversial; for this reason the aim of our research is to evaluate whether the preemptive use of ketamine decreases postoperative pain in patients undergoing appendectomy.
In double-blind, randomized clinical trial, 100 patients underwent appendectomy for acute appendicitis were studied. Patients were randomly assigned into two groups. In the operating room, patients in the ketamine group received 0.5 mg/kg of ketamine IV 10 minutes before the surgical incision. In control group the same volume of normal saline was injected. Pain intensity was assessed at time 0 (the time of complete consciousness), 4, 12, 24 hours postoperatively using the visual analogue scale (VAS). One hundred patients (50 for both groups) were enrolled. For all the evaluated times, the VAS score was significantly lower (p value <0.05) in the ketamine group compared to the control group. There was a highly significant difference between the groups regarding the interval time of analgesic need. The total dose of tramadol in the first 24 hours was 2.42±0.70mg/kg in ketamine group and 3.86±0.35mg/kg in control group (p=0.009). The occurrence of nausea and vomiting in ketamine group was less than in control group. Three patients experienced brief nondisturbing hallucination in the recovery room in ketamine group. No other drug side effects in ketamine group were noticed.
In conclusion, low dose of intravenously administered ketamine had a preemptive effect in reducing pain after appendectomy.
Basrah Journal of Surgery,
2008, Volume 14, Issue 2, Pages 0-0
Adjuvant analgesics are drugs that have weak or nonexistent analgesic action when
administered alone, but can enhance analgesic action when co-administered with known
analgesic agents. Ketamine, an anesthetic drug, is an adjuvant analgesic drug. Its use in doses
lower than therapeutic doses might be important in the management of certain types of pain as
The present study was performed to investigate the effects of subanesthetic doses of ketamine
in four animal models of induced pain and to compare its effects with diclofenac sodium. It is
also intended to test the effectiveness of combining both drugs together in these animal models
All experiments were performed on albino mice. Mice were evaluated for their responsiveness
to noxious stimuli using four tests: tail-flick test, hot-plate test, formalin test and acetic acidinduced
writhing test. These effects were measured before and one hour after intraperitoneal
drug administration. In some experiments, they were followed for 6 and 24 hours.
We found that Ketamine, in subanesthetic doses, resulted in a significant analgesic effect in all
the four models of pain. It increased pain latencies in tail-flick test by 78% compared to preadministration
time, and by 95% in hot plate test. It also decreased the number of lickings and
bitings in formalin test by 41.9% and the number of abdominal writhing by 73.5%. These
analgesic effects represented around 60% of diclofenac effect in heat-induced pain models, but
it is similar to diclofenac in the other two models. The enhancement of diclofenac analgesic
effect by ketamine ranged from 13.6% to 46% in the four tests.
It is concluded that Ketamine in subanesthetic doses has a significant analgesic effect
comparable to diclofenac. It can enhance diclofenac effect by a margin not exceeding 50% of
diclofenac effect. Much smaller doses of ketamine are required to be tested in the future.