Sami Mebazaa Mhamed, Mestiri Tahar, Kaabi Boubaker, Ben Ammar Mohamed Salah
Service d'Anesthésie Réanimation Urgences, Hôpital Mongi Slim, Tunisie.
Tunis Med. 2008 May;86(5):435-40.
combination of ketamine may improve morphine patient controlled analgesia (PCA) but clinical results are still equivocal.
The authors designed a powerful study to evaluate this hypothesis after major abdominal surgery.
138 patients undergoing abdominal surgery participated in the randomized double blind study. Patients were allocated to two groups: M-group: morphine 0.5 mg/ml + placebo in PCA and MK-group: morphine 0.5 mg/ml + ketamine 0.5 mg/ml with the same bolus dose and lock out time. The patients were evaluated during 48 hours by visual analog scale (VAS), simplified verbal scale (SVS). Side effects and amount of morphine used were monitored.
The two groups are comparable for demographic data and surgery characteristics. From the 24th hour, morphine consumption was significantly lower in the MK-group. At 48 hours after surgery, the amount of morphine received in the MK-group was significantly lower than in the M-group (48 vs 66 mg, p < 0.001). The average value of VAS was lower in the MK-group from the 12th hour at rest and 20th hour during mobilization. SVS was significantly lower for the MK-group after the 12th postoperative hour. The incidence of respiratory depression was higher in the M-group: 4 vs none in the MK-group. The incidence of nausea, vomiting and pruritus was halved in the MK-group (p < 0.04).
The combination of ketamine with morphine in PCA after major abdominal surgery offers a reduction of the morphine consumption, a reduction of pain scores and a decrease in the incidence of adverse effects.
氯胺酮联合使用可能改善吗啡患者自控镇痛（PCA），但临床结果仍不明确。
作者设计了一项有力的研究，以评估腹部大手术后的这一假设。
138例接受腹部手术的患者参与了随机双盲研究。患者被分为两组：M组：PCA中使用0.5mg/ml吗啡+安慰剂；MK组：PCA中使用0.5mg/ml吗啡+0.5mg/ml氯胺酮，推注剂量和锁定时间相同。通过视觉模拟评分法（VAS）、简化言语评分法（SVS）在48小时内对患者进行评估。监测副作用和吗啡使用量。
两组在人口统计学数据和手术特征方面具有可比性。从第24小时起，MK组的吗啡消耗量显著降低。术后48小时，MK组接受的吗啡量显著低于M组（48mg对66mg，p<0.001）。静息时从第12小时起、活动时从第20小时起，MK组的VAS平均值较低。术后第12小时后，MK组的SVS显著较低。M组呼吸抑制的发生率较高：4例，而MK组无。MK组恶心、呕吐和瘙痒的发生率减半（p<0.04）。
腹部大手术后PCA中氯胺酮与吗啡联合使用可减少吗啡消耗量、降低疼痛评分并减少不良反应的发生率。
