Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA.
Anesthesiology. 2010 Sep;113(3):639-46. doi: 10.1097/ALN.0b013e3181e90914.
Ketamine is an N-methyl-d-aspartate receptor antagonist that has been shown to be useful in the reduction of acute postoperative pain and analgesic consumption in a variety of surgical interventions with variable routes of administration. Little is known regarding its efficacy in opiate-dependent patients with a history of chronic pain. We hypothesized that ketamine would reduce postoperative opiate consumption in this patient population.
This was a randomized, prospective, double-blinded, and placebo-controlled trial involving opiate-dependent patients undergoing major lumbar spine surgery. Fifty-two patients in the treatment group were administered 0.5 mg/kg intravenous ketamine on induction of anesthesia, and a continuous infusion at 10 microg kg(-1) min(-1) was begun on induction and terminated at wound closure. Fifty patients in the placebo group received saline of equivalent volume. Patients were observed for 48 h postoperatively and followed up at 6 weeks. The primary outcome was 48-h morphine consumption.
Total morphine consumption (morphine equivalents) was significantly reduced in the treatment group 48 h after the procedure. It was also reduced at 24 h and at 6 weeks. The average reported pain intensity was significantly reduced in the postanesthesia care unit and at 6 weeks. The groups had no differences in known ketamine- or opiate-related side effects.
Intraoperative ketamine reduces opiate consumption in the 48-h postoperative period in opiate-dependent patients with chronic pain. Ketamine may also reduce opioid consumption and pain intensity throughout the postoperative period in this patient population. This benefit is without an increase in side effects.
氯胺酮是一种 N-甲基-D-天冬氨酸受体拮抗剂，已被证明在多种手术干预中，通过不同的给药途径，对急性术后疼痛和镇痛药物消耗的减少都有作用。关于其在有慢性疼痛病史的阿片类药物依赖患者中的疗效知之甚少。我们假设氯胺酮在这种患者人群中会减少术后阿片类药物的消耗。
这是一项随机、前瞻性、双盲、安慰剂对照试验，涉及接受大腰椎手术的阿片类药物依赖患者。治疗组 52 例患者在麻醉诱导时给予 0.5mg/kg 静脉注射氯胺酮，并在诱导时开始以 10μg/kg/min 的速度持续输注，直至伤口关闭。安慰剂组 50 例患者给予等量生理盐水。术后观察 48 小时，并在 6 周时进行随访。主要结果是 48 小时吗啡消耗量。
治疗组术后 48 小时总吗啡消耗量（吗啡等效物）明显减少。在 24 小时和 6 周时也有所减少。在麻醉后护理单元和 6 周时，报告的平均疼痛强度明显降低。两组在已知的氯胺酮或阿片类药物相关副作用方面没有差异。
术中氯胺酮可减少慢性疼痛的阿片类药物依赖患者术后 48 小时内的阿片类药物消耗。氯胺酮还可能减少此类患者人群整个术后期间的阿片类药物消耗和疼痛强度。这种益处不会增加副作用。
