Nitta Rie, Goyagi Toru, Nishikawa Toshiaki
Department of Anesthesia and Intensive Care Medicine, Akita University, Graduate School of Medicine, Akita, Japan.
Acta Anaesthesiol Taiwan. 2013 Mar;51(1):14-7. doi: 10.1016/j.aat.2013.03.003. Epub 2013 May 3.
Because ketamine, clonidine, and morphine modulate nociceptive pain, coadministration of these drugs would augment the activity of postoperative analgesic drugs. The purpose of this study was to evaluate the effects of coadministration of ketamine and clonidine on postoperative morphine consumption in patients after spine surgery.
The patients undergoing spine surgery were allocated randomly to one of the four study groups, which are as follows: group M (n = 12), intravenously (IV) administered patient-controlled analgesia (PCA) morphine alone; group MK (n = 12), IV-PCA morphine plus intra- and postoperative ketamine; group MC (n = 13), IV-PCA morphine plus oral clonidine premedication; group MCK (n = 12), IV-PCA morphine plus intra- and postoperative ketamine and clonidine premedication. The patients in the MC and MCK groups received 4 μg/kg clonidine orally, whereas those in the MK and MCK groups received IV bolus of ketamine (10 mg) at a rate of 2 mg/kg/hour during anesthesia. Patients were arranged to use IV-PCA mode for administration of drugs, which was programmed to deliver a bolus dose of 2-mg morphine (groups M and MC), or boluses of 2-mg morphine and 2-mg ketamine (groups MK and MCK). Scores of visual analog scale (VAS) for pain, morphine requirement, vital signs, nausea, sedation, and other side effects were followed up to 60 hours after surgery.
Although there were significant differences in VAS pain scores at rest 24-48 hours after the surgery, the VAS pain score at movement was similar among the groups. The number of PCA request and cumulative morphine requirement were significantly lower in the MCK group than in the M group.
This study results show that the administration of perioperative low-dose ketamine combined with clonidine premedication could reduce the consumption of postoperative PCA morphine following spine surgery.
由于氯胺酮、可乐定和吗啡可调节伤害性疼痛，联合使用这些药物会增强术后镇痛药的活性。本研究的目的是评估氯胺酮与可乐定联合使用对脊柱手术后患者术后吗啡用量的影响。
接受脊柱手术的患者被随机分配到以下四个研究组之一：M组（n = 12），仅静脉注射（IV）患者自控镇痛（PCA）吗啡；MK组（n = 12），IV-PCA吗啡加术中和术后氯胺酮；MC组（n = 13），IV-PCA吗啡加口服可乐定进行术前用药；MCK组（n = 12），IV-PCA吗啡加术中和术后氯胺酮及可乐定术前用药。MC组和MCK组的患者口服4 μg/kg可乐定，而MK组和MCK组的患者在麻醉期间以2 mg/kg/小时的速率静脉推注氯胺酮（10 mg）。患者采用IV-PCA模式给药，程序设定为给予2 mg吗啡推注剂量（M组和MC组），或2 mg吗啡和2 mg氯胺酮推注剂量（MK组和MCK组）。术后随访60小时，观察疼痛视觉模拟量表（VAS）评分、吗啡需求量、生命体征、恶心、镇静及其他副作用。
尽管术后24 - 48小时静息时VAS疼痛评分存在显著差异，但各组运动时的VAS疼痛评分相似。MCK组的PCA请求次数和吗啡累积需求量显著低于M组。
本研究结果表明，围手术期给予低剂量氯胺酮联合可乐定术前用药可减少脊柱手术后术后PCA吗啡的用量。
