ORIGINAL ARTICLES  ANESTHESIOLOGY Free access

Minerva Anestesiologica 2004 October;70(10):727-38

Copyright © 2004 EDIZIONI MINERVA MEDICA

language: English, Italian

Preemptive ketamine during general anesthesia for postoperative analgesia in patients undergoing laparoscopic cholecystectomy

Launo C., Bassi C., Spagnolo L., Badano S., Ricci C., Lizzi A., Molinino M.

Section of Anesthesia and Intensive Care, Department of Surgery, Anesthesia and Transplants (DISCAT), School of Anesthesia and Intensive Care, University of Genoa, Genoa, Italy

Aim. Preemptive anal­ge­sia is cur­rent­ly in use in the man­age­ment of post­op­er­a­tive ­pain and no ­more ­under ­search. The admin­is­tra­tion of ket­a­mine as intra­op­er­a­tive anal­ge­sic ­agent is ­well-known ­since a ­long ­time; the anal­ge­sic prop­er­ties of ­this ­drug are relat­ed to its ­actions as a non-com­pet­i­tive N-meth­yl-D-aspar­tate recep­tors antag­o­nist; ­these recep­tors ­present an excit­a­to­ry func­tion on ­pain trans­mis­sion and ­this bind­ing ­seems to pre­vent or ­reverse the cen­tral sen­sit­isa­tion of eve­ry ­kind of ­pain, includ­ing post­op­er­a­tive ­pain. In lit­er­a­ture, the use of ­this anes­thet­ic for the pre­emp­tive anal­ge­sia in the man­age­ment of post­op­er­a­tive ­pain is con­tro­ver­sial; for ­this rea­son the aim of our ­study was the clin­i­cal eval­u­a­tion of pre­emp­tive per­i­op­er­a­tive anal­ge­sia ­with low-dos­es ket­a­mine.
Methods. This ­trial ­involved 40 ­patients under­go­ing lapar­os­cop­ic chol­e­cys­tec­to­my, ­with the ­same sur­gi­cal oper­a­tor; post­op­er­a­tive anal­ge­sia was per­formed ­with the intra­op­er­a­tive admin­is­tra­tion of ket­a­mine (0.7 mg/kg) or tram­a­dol (15 mg/kg). A ran­dom­ized, dou­ble-­blind ­study was per­formed; ­after an inhal­a­to­ry/anal­ge­sic gen­er­al anes­the­sia (sev­o­flu­o­rane + remi­fen­ta­nyl) the post­op­er­a­tive-­pain con­trol was clin­i­cal­ly eval­u­at­ed ­through algo­met­ric meas­ure­ments (Visual Analog Scale, Verbal Rating Scale, Pain Intensity Difference); sup­ple­men­tal dos­es of tram­a­dol ­were admin­is­tered if ­required, ­also to quan­ti­fy the ade­qua­cy of anal­ge­sia, and ­adverse ­effects ­were eval­u­at­ed.
Results. The ­results ­show ­that pre­emp­tive intra­op­er­a­tive anal­ge­sia ­with ket­a­mine pro­duc­es a ­good anal­ge­sia at the awak­en­ing, ­despite low dura­tion (approx­i­mate­ly 1 ­hour), and ­upgrades the anal­ge­sic ­effect of tram­a­dol in the post­op­er­a­tive peri­od. Among the ­adverse ­effects, ­some (for exam­ple nau­sea) ­were relat­ed to the admin­is­tra­tion of ­both anal­ge­sics and to the ­kind of sur­gery, oth­ers (hal­lu­cin­o­sis, nys­tag­mus, pho­to­pho­bia, psy­cho­mo­tor exci­ta­tion, psy­chot­ic symp­toms) ­were due to ket­a­mine, and oth­ers (res­pir­a­to­ry depres­sion and hypo­ten­tion) ­could be relat­ed to tram­a­dol. Although the ­adverse ­effects due to ket­a­mine are ­more numer­ous ­than ­those relat­ed to tram­a­dol, the sec­ond ­could poten­tial­ly be ­more dan­ger­ous.
Conclusion. Our ­study sug­gests ­that pre­emp­tive low-dos­es ket­a­mine is ­able to pro­duce an ade­quate post­op­er­a­tive anal­ge­sia and increas­es the anal­ge­sic ­effect of tram­a­dol; fur­ther­more, ket­a­mine ­adverse ­effects ­could be ­reduced by intra­op­er­a­tive admin­is­tra­tion of ben­zod­i­az­e­pines and/or anti­emet­ic ­drugs, or by the asso­ci­a­tion of ket­a­mine and a periph­er­al anal­ge­sic (ketor­o­lac).