Lux E A, Haack T, Hinrichs K, Mathejka E, Wilhelm W
Klinik für Schmerz- und Palliativmedizin, Klinikum Lünen - St.-Marien-Hospital, Lünen.
Anaesthesist. 2009 Oct;58(10):1027-34. doi: 10.1007/s00101-009-1607-z.
In this study the impact of 25 mg of ketamine racemate given just before surgery on recovery times and postoperative analgesic needs in patients undergoing vaginal hysterectomy and receiving propofol-remifentanil anaesthesia was investigated.
With ethics committee approval 70 female patients aged 25-65 years were enrolled. All patients received a total intravenous anaesthesia with remifentanil and propofol with the propofol infusion being controlled to a Narcotrend index of 40. Patients in the ketamine group (n=35) received additionally a bolus dose of 25 mg ketamine racemate intravenously 3 min before skin incision. In addition to monitoring haemodynamics and circulation parameters, recovery times, postoperative pain and opioid needs were also recorded. Patients were also questioned on their satisfaction with the pain therapy.
All 70 patients completed the study and the groups were similar with respect to demographic data. The haemodynamics of the patients were stable in both groups and the postoperative pain measured over a 24-h period as well as the opioid needs were also comparable. However, recovery times were significantly prolonged in the ketamine group, e.g. the times to extubation were 8.3+/-4.0 min with ketamine compared to 6.1+/-2.1 min in the control group (p<0.01). Undesired side effects were overall rare but occurred to the same extent in both groups.
This study demonstrated that 25 mg ketamine racemate given just before surgery significantly prolongs recovery times without reducing post-operative analgesic needs when applied to patients undergoing vaginal hysterectomy and receiving propofol-remifentanil anaesthesia. A bolus dose of 25 mg ketamine racemate cannot therefore be recommended for preemptive analgesia under these conditions.
本研究调查了在接受丙泊酚-瑞芬太尼麻醉的阴道子宫切除术患者中，术前即刻给予25mg消旋氯胺酮对恢复时间和术后镇痛需求的影响。
经伦理委员会批准，纳入70例年龄在25至65岁之间的女性患者。所有患者均接受瑞芬太尼和丙泊酚全静脉麻醉，丙泊酚输注控制在脑电双频指数为40。氯胺酮组（n = 35）的患者在皮肤切开前3分钟额外静脉注射25mg消旋氯胺酮。除监测血流动力学和循环参数外，还记录恢复时间、术后疼痛和阿片类药物需求。还询问了患者对疼痛治疗的满意度。
所有70例患者均完成研究，两组在人口统计学数据方面相似。两组患者的血流动力学均稳定，24小时内测量的术后疼痛以及阿片类药物需求也相当。然而，氯胺酮组的恢复时间显著延长，例如，氯胺酮组拔管时间为8.3±4.0分钟，而对照组为6.1±2.1分钟（p<0.01）。总体而言，不良副作用很少见，但两组发生率相同。
本研究表明，对于接受丙泊酚-瑞芬太尼麻醉的阴道子宫切除术患者，术前即刻给予25mg消旋氯胺酮可显著延长恢复时间，且不减少术后镇痛需求。因此，在这些情况下，不推荐使用25mg消旋氯胺酮推注剂量进行超前镇痛。
