Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Deajeon, Korea.
Korean J Anesthesiol. 2011 Sep;61(3):238-43. doi: 10.4097/kjae.2011.61.3.238. Epub 2011 Sep 23.
Remifentanil is useful during general anesthesia because of its rapid onset and short acting time. However, some studies report that due to opioid-induced hyperalgesia (OIH) and tolerance, remifentanil also increases early postoperative pain. The occurrence of OIH and opioid-induced tolerance is mainly thought to be due to central sensitization by the activation of NMDA receptors. Therefore, we investigated the effects of continuous infusion of ketamine, an NMDA receptor antagonist, on postoperative pain and the quantity of opioids used.
40 patients scheduled to undergo laparoscopic gynecologic surgery were randomly allocated into two groups. Anesthesia was equally maintained with sevoflurane and 4 ng/ml of remifentanil in all patients. Ketamine (0.3 mg/kg) was injected and followed with a continuous dosage of 3 µl/kg/min in the ketamine group (n = 20) while the control group was injected and infused with an equal amount of normal saline. We compared postoperative VAS up to 7 hours and morphine demand through PCA.
Postoperative VAS and morphine demand was significantly lower in the ketamine group 2 and 3 hours after surgery, respectively.
When general anesthesia is maintained with sevoflurane and remifentanil in patients undergoing laparoscopic gynecologic surgery, continuous infusion of low dose ketamine decreased early postoperative pain and the quantity of opioids used.
瑞芬太尼由于起效迅速、作用时间短，在全身麻醉中很有用。然而，一些研究报告称，由于阿片类药物引起的痛觉过敏（OIH）和耐受，瑞芬太尼也会增加术后早期疼痛。OIH 和阿片类药物耐受的发生主要被认为是由于 NMDA 受体的激活导致中枢敏化。因此，我们研究了连续输注 NMDA 受体拮抗剂氯胺酮对术后疼痛和阿片类药物用量的影响。
40 例行腹腔镜妇科手术的患者被随机分为两组。所有患者的麻醉均由七氟醚和 4ng/ml 的瑞芬太尼维持。在氯胺酮组（n=20）中，患者给予 0.3mg/kg 的氯胺酮注射，并随后以 3µl/kg/min 的持续剂量输注，而对照组则给予等量的生理盐水注射和输注。我们比较了术后 7 小时内的 VAS 和 PCA 需求的吗啡用量。
术后 2 小时和 3 小时，氯胺酮组的 VAS 和吗啡需求明显降低。
在接受腹腔镜妇科手术的患者中，以七氟醚和瑞芬太尼维持全身麻醉时，连续输注低剂量氯胺酮可减轻术后早期疼痛和阿片类药物用量。
