1
|
Fahad Najam M, Jafri N. A Comparison Between the Effectiveness of Ketamine Bolus and Intradermal Lidocaine in Reducing Acute Postoperative Pain. Cureus 2022; 14:e26563. [PMID: 35936181 PMCID: PMC9349481 DOI: 10.7759/cureus.26563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2022] [Indexed: 11/05/2022] Open
Abstract
Background and objective In light of the scarcity of data and research about the management of pain in a low-resource setting, we conducted this study with a view to assessing the effectiveness of intravenous ketamine in comparison to that of intradermal lidocaine in reducing postoperative pain. Postoperative pain can lead to significant morbidity, longer hospital stay, and the development of chronic pain. Our study was formulated to assess the effectiveness of a ketamine bolus in comparison to intradermal lidocaine at the wound site in terms of decreasing pain scores postoperatively. Methods In our study, 99 patients were randomly selected to undergo inguinal hernia repair under spinal anesthesia. After obtaining informed consent from the participants and approval from the hospital ethical committee, the patients were randomly classified into the following three groups: the lidocaine group (group A), the ketamine group (group B), and the control group (group C). The patients in the lidocaine group received 0.6 mL/kg of 0.25% lidocaine (1.5 mg/kg) infiltration at the wound site. The ketamine group was given a 50-mg ketamine bolus at the end of the operation, and the control group did not receive either ketamine or intradermal lidocaine at the wound site. Postoperative pain was recorded using the Visual Analog Scale (VAS) scoring and the results were compared. The time of the first request for analgesia was also recorded. Results The pain scores measured via VAS scores were higher in patients who received intradermal lidocaine (group A) at the wound site as compared to group B that received a bolus of 50-mg ketamine (p<0.0001); the control group (group C) had pain scores higher than both groups A and B (p=0.0001). Conclusion Based on our findings, administering ketamine bolus can significantly decrease VAS scores and reduce the incidence of chronic post-surgical pain as compared to lidocaine infiltration. Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, provides excellent pain relief and analgesia, which decreases overall pain scores.
Collapse
|
2
|
Sarvari HR, Baigrezaii H, Nazarianpirdosti M, Meysami A, Safari-Faramani R. Comparison of the efficacy of intranasal ketamine versus intravenous ketorolac on acute non-traumatic headaches: a randomized double-blind clinical trial. Head Face Med 2022; 18:1. [PMID: 34980184 PMCID: PMC8722273 DOI: 10.1186/s13005-021-00303-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/07/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Non - traumatic headaches are one of the most common causes of referral to hospital emergency. This study aimed to compare the efficacy of intranasal ketamine and intravenous ketorolac on acute non-traumatic headaches. METHODS This randomized and double-blind clinical trial was conducted in 2019. One hundred and forty samples were randomly divided into intranasal ketamine (A) and intravenous ketorolac (B). Group (A) received ketamine intranasal (0.75 mg/kg, max 75 mg), and group B received intravenous ketorolac (30 mg). Headache severity was measured on arrival, 30, 60, and 120 min after intervention with Visual Analogue Scale (VAS). The side effects were recorded an hour after the intervention. RESULT The mean difference of pain intensity 30, 60, and 120 min after the intervention between the two groups was statistically significant (p < 0.001). In the first 30 min, significant changes were observed in the VAS levels of the two groups. These changes were significantly greater in the intranasal ketamine group (p < 0.001). Side effects such as fatigue, dizziness, general discomfort, nausea, increased heart rate, and hypertension were significantly higher in the ketamine group (p < 0.05). CONCLUSION Intranasal ketamine and intravenous ketorolac both effectively reduced headaches. However, more analgesic effects of intranasal ketamine in a short time can be considered as a selective approach to reducing headaches. TRIAL REGISTRATION IRCT20180108038276N3 , Registered 29 September 2019. ETHICS COMMITTEE REFERENCE NUMBER IR.KUMS.REC.1398.068.
Collapse
Affiliation(s)
- Hooman Rafiei Sarvari
- Department of Emergency Medicine, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hamidreza Baigrezaii
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Amirhossein Meysami
- Department of Emergency Medicine, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Roya Safari-Faramani
- Department of Epidemiology, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| |
Collapse
|
3
|
Sotoodehnia M, Farmahini-Farahani M, Safaie A, Rasooli F, Baratloo A. Low-dose intravenous ketamine versus intravenous ketorolac in pain control in patients with acute renal colic in an emergency setting: a double-blind randomized clinical trial. Korean J Pain 2019; 32:97-104. [PMID: 31091508 PMCID: PMC6549592 DOI: 10.3344/kjp.2019.32.2.97] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 01/16/2019] [Accepted: 01/23/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND This study was conducted to compare the effectiveness of low-dose ketamine versus ketorolac in pain control in patients with acute renal colic presenting to the emergency department (ED). METHODS This is a double-blind randomized clinical trial. The initial pain severity was assessed using the numerical rating scale (NRS). Then, ketamine or ketorolac was administered intravenously at a dose of 0.6 mg/kg and 30 mg respectively. The pain severity and adverse drug reactions were recorded 5, 15, 30, 60, and 120 min thereafter. RESULTS The data of 62 subjects in the ketamine group and 64 patients in the ketorolac group were analyzed. The mean age of the patients was 34.2 ± 9.9 and 37.9 ± 10.6 years in the ketamine and ketorolac group, respectively. There was no significant difference in the mean NRS scores at each time point, except for the 5 min, between the two groups. Despite a marked decrease in pain severity in the ketamine group from drug administration at the 5 min, a slight increase in pain was observed from the 5 min to the 15 min. The rate of adverse drug reactions, including dizziness (P = 0.001), agitation (P = 0.002), increased systolic blood pressure (> 140 mmHg), and diastolic blood pressure (> 90 mmHg) was higher in the ketamine group. CONCLUSIONS Low dose ketamine is as effective as ketorolac in pain management in patients with renal colic presenting to the ED. However, it is associated with a higher rate of adverse drug reactions.
Collapse
Affiliation(s)
- Mehran Sotoodehnia
- Prehospital Emergency Research Center and Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mozhgan Farmahini-Farahani
- Prehospital Emergency Research Center and Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Safaie
- Prehospital Emergency Research Center and Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Rasooli
- Prehospital Emergency Research Center and Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Baratloo
- Prehospital Emergency Research Center and Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
4
|
Saxena D, Dixit A, Kumar N, Arya B, Sanwatsarkar S, Bhandari S. Efficacy of Low-dose Ketamine as Sole Analgesic Agent in Maintaining Analgesia and Intraoperative Hemodynamics During Laparoscopic Gynecological Surgeries. Anesth Essays Res 2017; 11:385-389. [PMID: 28663627 PMCID: PMC5490101 DOI: 10.4103/0259-1162.206276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Ketamine, in low doses, is known to possess intense analgesic properties. The available literature shows wide variation regarding the time and dose of administration of ketamine during surgery. AIM The aim of this study was to evaluate the effect of intraoperative administration of ketamine when used as sole analgesic in low doses, on hemodynamics and postoperative analgesia in patients undergoing laparoscopic gynecological surgery and compared on the basis of duration of surgery. SETTINGS AND DESIGN This prospective, observational study was conducted from July to December 2015, over a period of 6 months in a tertiary care medical college and hospital. MATERIALS AND METHODS Seventy patients between 23 and 55 years planned for laparoscopic gynecological surgery were recruited. Ketamine was given in a dose of 0.5 mg/kg preoperatively and then repeated every ½ hourly in a dose of 0.25 mg/kg throughout the surgery. Hemodynamic parameters, time to the first rescue analgesia and complications were recorded for the first 8 h. Statistical evaluation was done and result expressed as percentage. Paired t-test was employed for the comparison of numerical variables within the group. RESULTS Seventy percent of the patients did not require any postoperative rescue analgesia during the first 8 h after surgery. None of the patients complained of pain immediately after extubation, and 16% of the patients had minor postoperative complications. The intraoperative hemodynamic profile was significantly altered. Duration of surgery and dose of ketamine required did not affect the duration of analgesia. CONCLUSION Ketamine in low dose proved to be an efficacious analgesic even in the long duration laparoscopic gynecological surgeries. It stabilizes intraoperative hemodynamics thereby reducing the requirement of other anesthetic and antihypertensive agents.
Collapse
Affiliation(s)
- Dipti Saxena
- Department of Anesthesiology, Sri Aurobindo Institute of Medical Sciences and Mohak Hi-Tech Hospital, Indore, Madhya Pradesh, India
| | - Atul Dixit
- Department of Anesthesiology, Sri Aurobindo Institute of Medical Sciences and Mohak Hi-Tech Hospital, Indore, Madhya Pradesh, India
| | - Naina Kumar
- Department of Anesthesiology, Sri Aurobindo Institute of Medical Sciences and Mohak Hi-Tech Hospital, Indore, Madhya Pradesh, India
| | - Bipin Arya
- Department of Anesthesiology, Sri Aurobindo Institute of Medical Sciences and Mohak Hi-Tech Hospital, Indore, Madhya Pradesh, India
| | - Sadhana Sanwatsarkar
- Department of Anesthesiology, Sri Aurobindo Institute of Medical Sciences and Mohak Hi-Tech Hospital, Indore, Madhya Pradesh, India
| | - Shilpa Bhandari
- Department of Reproductive Medicine, Sri Aurobindo Institute of Medical Sciences and Mohak Hi-Tech Hospital, Indore, Madhya Pradesh, India
| |
Collapse
|
5
|
Abstract
Laparoscopic surgery is widespread, and an increasing number of surgeries are performed laparoscopically. Early pain after laparoscopy can be similar or even more severe than that after open surgery. Thus, proactive pain management should be provided. Pain after laparoscopic surgery is derived from multiple origins; therefore, a single agent is seldom sufficient. Pain is most effectively controlled by a multimodal, preventive analgesia approach, such as combining opioids with non-opioid analgesics and local anaesthetics. Wound and port site local anaesthetic injections decrease abdominal wall pain by 1-1.5 units on a 0-10 pain scale. Inflammatory pain and shoulder pain can be controlled by NSAIDs or corticosteroids. In some patient groups, adjuvant drugs, ketamine and α2-adrenergic agonists can be helpful, but evidence on gabapentinoids is conflicting. In the present review, the types of pain that need to be taken into account while planning pain management protocols and the wide range of analgesic options that have been assessed in laparoscopic surgery are critically assessed. Recommendations to the clinician will be made regarding how to manage acute pain and how to prevent persistent postoperative pain. It is important to identify patients at the highest risk for severe and prolonged post-operative pain, and to have a proactive strategy in place for these individuals.
Collapse
|
6
|
Abstract
This paper is the thirty-sixth consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2013 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior, and the roles of these opioid peptides and receptors in pain and analgesia; stress and social status; tolerance and dependence; learning and memory; eating and drinking; alcohol and drugs of abuse; sexual activity and hormones, pregnancy, development and endocrinology; mental illness and mood; seizures and neurologic disorders; electrical-related activity and neurophysiology; general activity and locomotion; gastrointestinal, renal and hepatic functions; cardiovascular responses; respiration and thermoregulation; and immunological responses.
Collapse
Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY 11367, United States.
| |
Collapse
|
7
|
Imantalab V, Mirmansouri A, Sedighinejad A, Naderi Nabi B, Farzi F, Atamanesh H, Nassiri N. Comparing the effects of morphine sulfate and diclofenac suppositories on postoperative pain in coronary artery bypass graft patients. Anesth Pain Med 2014; 4:e19423. [PMID: 25346897 PMCID: PMC4205802 DOI: 10.5812/aapm.19423] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 05/12/2014] [Accepted: 08/18/2014] [Indexed: 12/31/2022] Open
Abstract
Background: Simple and efficient way of pain management after Coronary Artery Bypass Graft (CABG) surgery is an important aspect of patients' care. Objectives: This study aimed to compare the effects of morphine and diclofenac suppositories on postoperative pain management. Patients and Methods: In this double-blinded clinical trial study, 120 patients aged 30-65 years old, undergone CABG, were equally divided into two groups of A (morphine) and B (diclofenac). All patients were anesthetized with intravenous fentanyl 10 μg/kg, etomidate 0.2 mg/kg and cisatracurium 0.2 mg/kg. Anesthesia was maintained with oxygen 50% and air 50%, propofol 50 μg/kg/min, fentanyl 1-2 μg/kg/h and atracurium 0.6 mg/kg/h. Analgesics were administered after the operation at intensive care unit (ICU) and Visual Analogue Score (VAS) was evaluated in both groups in 4-hour intervals after extubation for 24 hours. After extubation in case of VAS > 3, morphine suppository 10 mg (group A) or diclofenac suppository 50 mg (group B) was administered for patients. Results: No significant statistical relationship was found between the two groups regarding gender, age, BMI, paracetamol consumption, length of operation time, cardiopulmonary bypass pump (CPB) time, and stay time at ICU (P Value ≥ 0.05). Total dosage of used morphine was 22 ± 8.3 mg in each patient and total dosage of used diclofenac was 94 ± 32.01 mg. Average variation of VAS at measured intervals was significant (P Value ≤ 0.0001), but these variations were not significantly different when comparing the two groups (P Value = 0.023). Conclusions: Both morphine and diclofenac suppositories reduced pain significantly and similarly after CABG surgery.
Collapse
Affiliation(s)
- Vali Imantalab
- Anesthesiology Department, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Mirmansouri
- Anesthesia Research Center, Dr. Heshmat Hospital, Guilan University of Medical Sciences, Rasht, Iran
- Corresponding author: Ali Mirmansouri, Anesthesia Research Center, Dr. Heshmat Hospital, Guilan University of Medical Sciences, Rasht, Iran. Tel: +98-9111315314, Fax: +98-1316668718,, E-mail:
| | - Abbas Sedighinejad
- Anesthesiology Department, Guilan University of Medical Sciences, Rasht, Iran
| | - Bahram Naderi Nabi
- Anesthesiology Department, Guilan University of Medical Sciences, Rasht, Iran
| | - Farnoush Farzi
- Anesthesiology Department, Guilan University of Medical Sciences, Rasht, Iran
| | - Hadi Atamanesh
- Anesthesiology Department, Guilan University of Medical Sciences, Rasht, Iran
| | - Nassir Nassiri
- Cardiac Surgery Department, Guilan University of Medical Sciences, Rasht, Iran
| |
Collapse
|
8
|
Zhou Z, Zhang G, Li X, Liu X, Wang N, Qiu L, Liu W, Zuo Z, Yang J. Loss of Phenotype of Parvalbumin Interneurons in Rat Prefrontal Cortex Is Involved in Antidepressant- and Propsychotic-Like Behaviors Following Acute and Repeated Ketamine Administration. Mol Neurobiol 2014; 51:808-19. [DOI: 10.1007/s12035-014-8798-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 06/15/2014] [Indexed: 01/19/2023]
|
9
|
Dahi-Taleghani M, Fazli B, Ghasemi M, Vosoughian M, Dabbagh A. Effect of intravenous patient controlled ketamine analgesiaon postoperative pain in opium abusers. Anesth Pain Med 2014; 4:e14129. [PMID: 24701419 PMCID: PMC3961031 DOI: 10.5812/aapm.14129] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Revised: 11/22/2013] [Accepted: 12/01/2013] [Indexed: 12/29/2022] Open
Abstract
Background: Acutepostoperative pain is among the worst experience that patient scan undergo, and many analgesics have been used to suppress it; especially in chronic opium abusers. Ketamine is an N-methyl-D-aspartate antagonist analgesic, having both anesthetic and analgesic properties, which are not affected to the same extent in chronic opium abusers. Objectives: In this study, we assessed the analgesic effects of ketamine added to morphine as a patient-controlled analgesia method for acute pain management, compared with a placebo, inchronic maleopium abusers. Patients and Methods: After institutional review board approval for ethical considerations, a randomized double-blinded placebo controlled clinical trial was conducted. A total of 140 male patients aged 18-65 years, undergoing orthopedic surgery, were entered into the study after matching inclusion and exclusion criteria. All patients received the same anesthesia method; while the first group received ketamine (1mg/mL) and morphine (0.5 mg/mL) as a patient-controlled analgesia (70 patients), the second group received morphine (0.5 mg/mL) plus normal saline (70 patients). P value less than 0.05 was considered statistically significant. Results: The ketamine and morphine group of patients experienced less postoperative pain and required less postoperative rescue analgesia. However, the unwanted postoperative side effects were nearly the same; although increased levels of postoperative nausea and vomiting were observed in the ketamine and morphine group Conclusions: This study demonstrated improved analgesic effects after using intravenous patient controlled analgesia with ketamine on postoperative pain in opium abusers.
Collapse
Affiliation(s)
- Mastane Dahi-Taleghani
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Benjamin Fazli
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahshid Ghasemi
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Vosoughian
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Dabbagh
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding author: Ali Dabbagh, Anesthesiology Research Center, ShahidBeheshti University of Medical Sciences, Tehran, Iran. Tel: +98-989121972368, Fax: +98-982122432572, E-mail: ,
| |
Collapse
|
10
|
Effects of the addition of low-dose ketamine to propofol-fentanyl anaesthesia during diagnostic gynaecological laparoscopy. Eur J Obstet Gynecol Reprod Biol 2013; 170:247-50. [PMID: 23870189 DOI: 10.1016/j.ejogrb.2013.06.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 02/27/2013] [Accepted: 06/24/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Diagnostic gynaecological laparoscopy (DGL) is a brief procedure, generally performed on an outpatient basis. Propofol-fentanyl is often used for anaesthesia in minor outpatient procedures because of its rapid onset, short duration of action and smooth patient awakening. However, propofol has various cardiovascular effects such as reduced arterial pressure, cardiac output and cardiac index. Ketamine is an intravenous anaesthetic and short-acting analgesic that could alleviate the haemodynamic effects of propofol due to its sympathomimetic activity. The aim of this placebo-controlled trial was to evaluate the effects of the addition of low-dose ketamine to propofol-fentanyl anaesthesia in DGL. STUDY DESIGN In this double-blind randomized trial, 60 healthy women undergoing gynaecological laparoscopy to investigate infertility were studied. Following injection of midazolam and fentanyl in all patients, the study group (n=30) received ketamine 0.5 mg/kg and propofol 1-2.5 mg/kg, and the placebo group (n=30) received saline 0.9% and propofol 1-2.5 mg/kg. Propofol was subsequently infused for the maintenance of anaesthesia. RESULTS Patients in the study group had a significantly lower incidence of pain than patients in the placebo group during propofol injection (13% vs 87%, respectively; p<0.0001). After induction of anaesthesia, 16 (53%) patients in the placebo group and three (10%) patients in the study group had a decreased heart rate (p<0.001). The decrease in mean arterial pressure was greater in the placebo group compared with the study group (37% vs 7%, respectively; p<0.001). During the procedure, the total mean±standard deviation dose of propofol was 420±65 mg in the placebo group and 330±35 mg in the study group (p<0.001). Pain scores for the first 3h after the operation were significantly lower in the study group (p<0.001). CONCLUSION Use of low-dose ketamine with propofol-fentanyl anaesthesia in patients undergoing DGL was associated with less pain during propofol injection, lower incidence of haemodynamic changes, lower total dose of propofol and improved postoperative analgesia.
Collapse
|