'Balanced analgesia' in the perioperative period: is there a place for ketamine?
'Balanced analgesia' in the perioperative period: is there a place for ketamine?
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DOI：
10.1016/s0304-3959(01)00278-0
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发表时间：
2001-06-01
期刊：
影响因子：
7.4
通讯作者：
Waterloos, H
中科院分区：
文献类型：
--
作者：
De Kock, M;Lavand'homme, P;Waterloos, H
我们研究了术中“亚麻醉剂量”氯胺酮是否具有术后抗痛觉和镇痛作用，以及哪种给药方式是全身（静脉、静脉）或硬膜外给药的首选途径。本研究纳入100例在硬膜外/全身联合麻醉下行直肠腺癌手术的患者。所有患者在切开皮肤前均接受硬膜外灌注，随后连续输注布比卡因/舒芬太尼/可乐定混合物。他们被随机分配到不接受氯胺酮（1组），静脉注射氯胺酮，剂量为0.25 mg/kg，随后每小时输注0.125 mg/kg（2组），0.5 mg/kg和0.25 mg/kg（3组），硬膜外氯胺酮0.25 mg/kg和0.125 mg/kg（4组），或0.5 mg/kg和0.25 mg/kg（5组）。手术结束时停用所有静脉注射和硬膜外镇痛药，并将患者连接到静脉注射吗啡患者自控镇痛（PCA）装置。通过休息、咳嗽和运动时的疼痛视觉模拟量表评分以及PCA要求来评估术后短期镇痛（72 h）。在第2周、第1、6、12个月询问患者，评估伤口机械性痛觉过敏和残余疼痛。第三组痛觉过敏面积和吗啡PCA需求明显减少。这些患者在术后6个月前报告的残余疼痛明显减少。这些观察结果支持以下理论：麻醉期间给予亚麻醉剂量的静脉注射氯胺酮（0.5 mg/kg，随后每小时0.25 mg/kg）可减少伤口痛觉过敏，是围手术期平衡镇痛的有用辅助。此外，它们还表明，系统性途径显然是优先途径。(C) 2001国际疼痛研究协会。Elsevier Science B.V.版权所有。
We investigated whether intraoperative 'subanesthetic doses' of ketamine have a postoperative anti-hyperalgesic and an analgesic effect and which is the preferential route of administration, either systemic (intravenous, i.v.) or epidural. One hundred patients scheduled for rectal adenocarcinoma surgery under combined epidural/general anesthesia were included. Before skin incision all the patients received an epidural bolus followed by an infusion of continuous bupivacaine/sufentanil/clonidine mixture. They were randomly assigned to receive no ketamine (group 1), i.v. ketamine at the bolus dose of 0.25 mg/kg followed by an infusion of 0.125 mg/kg per h (group 2), 0.5 mg/kg and 0.25 mg/kg per h (group 3), epidural ketamine 0.25 mg/kg and 0.125 mg/kg per h (group 4), or 0.5 mg/kg and 0.25 mg/kg per h (group 5). All i.v. and epidural analgesics were stopped at the end of surgery and patients were connected to an i.v. morphine patient-controlled analgesia (PCA) device. Short-term postoperative analgesia (72 h) was assessed by pain visual analog scale scores at rest, cough, and movements as well as by PCA requirements. Wound mechanical hyperalgesia was evaluated and residual pain was assessed by asking the patients at 2 weeks, and 1, 6, and 12 months. The area of hyperalgesia and morphine PCA requirements were significantly reduced in group 3. These patients reported significantly less residual pain until the sixth postoperative month. These observations support the theory that subanesthetic doses of i.v. ketamine (0.5 mg/kg bolus followed by 0.25 mg/kg per h) given during anesthesia reduce wound hyperalgesia and are a useful adjuvant in perioperative balanced analgesia. Moreover, they show that the systemic route clearly is the preferential route. (C) 2001 International Association for the Study of Pain. Published by Elsevier Science B.V. All rights reserved.