Jensen L L, Handberg G, Helbo-Hansen H S, Skaarup I, Lohse T, Munk T, Lund N
Department of Anaesthesiology and Intensive Care Medicine, Odense University Hospital, DK-5000 Odense C, Denmark.
Acta Anaesthesiol Scand. 2008 Apr;52(4):479-86. doi: 10.1111/j.1399-6576.2008.01602.x.
Pain following embolization of the uterine arteries (UAEs) is variable and may be very severe requiring large doses of parenteral opioids for relief. The present study tested the hypothesis that the addition of ketamine to i.v. patient-controlled morphine reduces the amount of morphine required for pain-control during the first 24 h after UAE embolization.
Fifty-six patients undergoing UAE embolization for treatment of symptomatic uterine leiomyomata were randomized to receive either 2 mg/ml of morphine (Control group, n=30) or 2 mg/ml of both morphine and ketamine (Ketamine group, n=26) by i.v. patient-controlled analgesia (IV-PCA). Pump settings were bolus dose 1 ml, lockout 10 min, no background infusion. In addition, all patients received diclofenac and acetaminophen for pain relief. Pain scores, morphine consumption and adverse events like nausea, vomiting, itching, visual disturbances, anxiety, dreaming and hallucinations, if any, were recorded for 24 h after embolization.
The mean +/- SD 24-h consumption of patient-controlled morphine was 38.3 +/- 21.0 mg in the Ketamine group vs. 33.3 +/- 18.3 mg in the Control group (NS). The difference between the means was 5.0 mg (95% confidence interval: -5.7; 15.6). One patient in the Ketamine group vs. none in the Control group experienced auditory hallucinations.
Studying an unselected group of patients undergoing embolization of the UAEs for treatment of symptomatic uterine leiomyomata under conditions of basal analgesia with acetaminophen and diclofenac, we failed to demonstrate any morphine-sparing effect of IV-PCA ketamine and morphine compared with IV-PCA morphine alone.
子宫动脉栓塞术（UAE）后疼痛程度因人而异，可能非常严重，需要大剂量胃肠外给予阿片类药物来缓解。本研究检验了以下假设：在静脉自控吗啡镇痛中添加氯胺酮可减少UAE栓塞术后首24小时内控制疼痛所需的吗啡量。
56例因有症状的子宫平滑肌瘤接受UAE栓塞术的患者被随机分为两组，分别通过静脉自控镇痛（IV-PCA）接受2mg/ml吗啡（对照组，n = 30）或2mg/ml吗啡加氯胺酮（氯胺酮组，n = 26）。泵的设置为：推注剂量1ml，锁定时间10分钟，无背景输注。此外，所有患者均接受双氯芬酸和对乙酰氨基酚以缓解疼痛。记录栓塞术后24小时的疼痛评分、吗啡用量以及恶心、呕吐、瘙痒、视觉障碍、焦虑、梦境和幻觉等不良事件（如有）。
氯胺酮组患者自控吗啡的24小时平均用量为38.3±21.0mg，而对照组为33.3±18.3mg（无显著性差异）。两组均值之差为5.0mg（95%置信区间：-5.7；15.6）。氯胺酮组有1例患者出现幻听，而对照组无。
在对乙酰氨基酚和双氯芬酸基础镇痛条件下，对一组未经过挑选、因有症状的子宫平滑肌瘤接受UAE栓塞术的患者进行研究，我们未能证明与单纯静脉自控吗啡相比，静脉自控氯胺酮和吗啡有任何节省吗啡的效果。
