Menigaux C, Guignard B, Fletcher D, Sessler D I, Dupont X, Chauvin M
Department of Anesthesiology, Hôpital Ambroise Pare, Boulogne-Billancourt, France.
Anesth Analg. 2001 Sep;93(3):606-12. doi: 10.1097/00000539-200109000-00016.
Ketamine may prevent postoperative hyperalgesia. In patients undergoing arthroscopic meniscectomy using general anesthesia, we tested whether a single intraoperative dose of ketamine enhanced postoperative analgesia and improved functional outcome compared with a typical multimodal analgesic regimen. After the induction of anesthesia, 50 patients were randomly assigned to ketamine (0.15 mg/kg IV just after the induction of anesthesia) or a vehicle placebo. Standardized general anesthesia included propofol, alfentanil, and nitrous oxide. Bupivacaine (0.5%) and morphine (5 mg) were given intraarticularly at the end of surgery. Postoperative analgesia was initially provided with morphine and subsequently with naproxen sodium (550 mg orally twice daily) and Di-Antalvic (400 mg acetaminophen and 30 mg dextropropoxyphene) as needed. Pain scores, analgesic requirements, side effects, and ability to walk were assessed in the ambulatory unit and at home for three postoperative days. Times to awakening and to discharge were similar in the two groups. However, the Ketamine group had significantly less postoperative pain at rest and during mobilization on Days 0, 1, and 2. Furthermore, they consumed significantly fewer Di-Antalvic tablets than the control group (13 [7-17] vs 27 [16-32], median [25%-75% interquartile range]). Patients given ketamine were also able to walk for longer periods of time on the first postoperative day. In conclusion, adding small-dose ketamine to a multimodal analgesic regimen improved postoperative analgesia and functional outcome after outpatient knee arthroscopy.
氯胺酮可能预防术后痛觉过敏。在接受全身麻醉的关节镜半月板切除术患者中，我们测试了与典型的多模式镇痛方案相比，术中单次给予氯胺酮是否能增强术后镇痛效果并改善功能结局。麻醉诱导后，50例患者被随机分配至氯胺酮组（麻醉诱导后立即静脉注射0.15mg/kg）或赋形剂安慰剂组。标准化全身麻醉包括丙泊酚、阿芬太尼和氧化亚氮。手术结束时在关节腔内注射布比卡因（0.5%）和吗啡（5mg）。术后最初用吗啡镇痛，随后根据需要给予萘普生钠（每日口服两次，每次550mg）和达而丰（对乙酰氨基酚400mg和右丙氧芬30mg）。在门诊病房和术后三天在家中评估疼痛评分、镇痛需求、副作用及行走能力。两组的苏醒时间和出院时间相似。然而，氯胺酮组在术后第0、1和2天休息和活动时的术后疼痛明显减轻。此外，他们服用的达而丰片明显少于对照组（中位数[四分位间距25%-75%]为13[7-17]片对27[16-32]片）。接受氯胺酮治疗的患者在术后第一天也能行走更长时间。总之，在多模式镇痛方案中添加小剂量氯胺酮可改善门诊膝关节镜检查后的术后镇痛效果和功能结局。
