| Morphine with adjuvant ketamine vs higher dose of morphine alone for immediate postthoracotomy analgesia. | |
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MedLine Citation:
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PMID: 18753471 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Thoracotomy is associated with severe pain. We hypothesized that the concomitant use of a subanesthetic dose of ketamine plus a two-third-standard morphine dose might provide more effective analgesia with fewer side effects than a standard morphine dose for early pain control. METHODS: We conducted a 6-month randomized, double-blind study in patients undergoing thoracotomy for minimally invasive direct coronary artery bypass or for lung tumor resection. After extubation, when objectively awake (>or= 5/10 visual analogue scale [VAS]) and complaining of pain (>or= 5/10 VAS), patients were connected to patient-controlled IV analgesia delivering 1.5 mg of morphine plus saline solution (MO) or 1.0 mg of morphine plus a 5-mg ketamine bolus (MK), with a 7-min lockout time. Rescue IM diclofenac, 75 mg, was available. Follow-up lasted 4 h. RESULTS: Forty-one patients completed the study. MO patients (n = 20) used 6.8 +/- 1.9 mg/h (mean +/- SD) and 5.5 +/- 3.6 mg/h of morphine during the first and second hours, respectively; MK patients (n = 21) used 3.7 +/- 1.2 mg/h and 2.8 +/- 2.3 mg/h, respectively (p < 0.01). The 4-h activation rate of the device was double in the MO patients than in the MK patients (66 +/- 54 vs 28 +/- 20, p < 0.001). The maximal self-rated pain score was 5.6 +/- 1.0 for the MO group vs 3.7 +/- 0.7 for the MK group (p < 0.01). Four MO patients vs one MK patient required diclofenac; 6 MO patients but no MK patients had oxygen saturation by pulse oximetry < 94% on a fraction of inspired oxygen of 0.4 (p < 0.01); two MO patients required reintubation. Paco(2) was higher in the MO group (40 +/- 6 mm Hg vs 33 +/- 5 mm Hg, p < 0.05). Heart rate, BP, and incidence of nausea/vomiting were similar; no ketamine-related hallucinations were detected. CONCLUSIONS: Subanesthetic ketamine combined with a 35%-lower morphine dose provided equivalent pain control compared to the standard morphine dose alone, with fewer adverse side effects and a 45% reduction in morphine consumption. Trial registration: ClinicalTrials.gov Identifier: NCT00625911. |
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Authors:
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Nachum Nesher; Margaret P Ekstein; Yoseph Paz; Nissim Marouani; Shoshana Chazan; Avi A Weinbroum |
Publication Detail:
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Type: Journal Article; Randomized Controlled Trial Date: 2008-08-27 |
Journal Detail:
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Title: Chest Volume: 136 ISSN: 1931-3543 ISO Abbreviation: Chest Publication Date: 2009 Jul |
Date Detail:
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Created Date: 2009-07-08 Completed Date: 2009-08-05 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0231335 Medline TA: Chest Country: United States |
Other Details:
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Languages: eng Pagination: 245-52 Citation Subset: AIM; IM |
Affiliation:
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Director, Post-Anesthesia Care Unit, Tel Aviv Sourasky Medical Center, 6 Weizman St, Tel Aviv 64239, Israel. draviw@tasmc.health.gov.il. |
| Data Bank Information | |
Bank Name/Acc. No.:
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ClinicalTrials.gov/NCT00625911 |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Analgesia, Patient-Controlled Analgesics, Opioid / administration & dosage* Anesthetics, Dissociative / administration & dosage* Coronary Artery Bypass Dose-Response Relationship, Drug Double-Blind Method Drug Therapy, Combination Female Humans Ketamine / administration & dosage* Lung Neoplasms / surgery Male Middle Aged Morphine / administration & dosage* Pain Measurement Pain, Postoperative / drug therapy*, etiology Thoracotomy / adverse effects* |
| Chemical | |
Reg. No./Substance:
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0/Analgesics, Opioid; 0/Anesthetics, Dissociative; 57-27-2/Morphine; 6740-88-1/Ketamine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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