Jabbour H J, Naccache N M, Jawish R J, Abou Zeid H A, Jabbour K B, Rabbaa-Khabbaz L G, Ghanem I B, Yazbeck P H
Departments of Anesthesia and Critical Care, Hôtel Dieu de France, Université Saint Joseph, Beirut, Lebanon.
Acta Anaesthesiol Scand. 2014 May;58(5):572-9. doi: 10.1111/aas.12304. Epub 2014 Mar 17.
Scoliosis repair is a major orthopaedic surgery associated with severe post-operative pain. Ketamine and magnesium have an established efficacy as morphine-sparing agents. Our purpose was to evaluate the morphine-sparing effect of both magnesium and ketamine given simultaneously compared with ketamine alone during scoliosis surgery.
Fifty patients scheduled for posterior instrumentation were randomised in a prospective double-blind study. The Gr (K + Mg) received, after induction, an intravenous (IV) bolus of ketamine 0.2 mg/kg and magnesium 50 mg/kg, followed by continuous infusion of ketamine (0.15 mg/kg/h) and magnesium (8 mg/kg/h) until extubation. The Gr (K) received the same dose of ketamine associated with bolus and continuous infusion of normal saline. All patients received multimodal analgesia associated with IV morphine administered via patient-controlled analgesia pump. Morphine consumption, visual analogue scale (VAS) pain scores and occurrence of side effects were followed until 48 h post-operatively. Sleep quality and patient satisfaction were also followed. P < 0.05 was considered statistically significant.
The average cumulative morphine consumption was significantly lower in the Gr (K + Mg) compared with the Gr (K) at post-operative hours 4, 8, 12, 18, 30, 36 and 48. The relative difference in the post-operative morphine consumption was 29.5%: Gr (K + Mg) 51.53 mg vs. Gr (K) 73.16 mg. VAS scores were not statistically different between the two groups. However, qualities of sleep and satisfaction scores on the first night were significantly better in the Gr (K + Mg) (P = 0.027 and P = 0.016, respectively).
Ketamine and magnesium association reduces the post-operative morphine consumption after scoliosis surgery. It seems to provide a better sleep quality and improves patient satisfaction.
脊柱侧弯修复术是一种大型骨科手术，术后疼痛剧烈。氯胺酮和镁作为吗啡节省剂已证实具有疗效。我们的目的是评估脊柱侧弯手术期间同时给予镁和氯胺酮与单独给予氯胺酮相比的吗啡节省效果。
在一项前瞻性双盲研究中，将50例计划进行后路器械植入的患者随机分组。Gr（K + Mg）组在诱导后静脉推注0.2 mg/kg氯胺酮和50 mg/kg镁，随后持续输注氯胺酮（0.15 mg/kg/h）和镁（8 mg/kg/h）直至拔管。Gr（K）组接受相同剂量的氯胺酮，并推注和持续输注生理盐水。所有患者均接受与通过患者自控镇痛泵静脉注射吗啡相关的多模式镇痛。记录术后48小时内的吗啡消耗量、视觉模拟评分（VAS）疼痛评分及副作用发生情况。同时记录睡眠质量和患者满意度。P < 0.05被认为具有统计学意义。
术后4、8、12、18、30、36和48小时，Gr（K + Mg）组的平均累积吗啡消耗量显著低于Gr（K）组。术后吗啡消耗量的相对差异为29.5%：Gr（K + Mg）组为51.53 mg，Gr（K）组为73.16 mg。两组间VAS评分无统计学差异。然而，Gr（K + Mg）组第一晚的睡眠质量和满意度评分显著更好（分别为P = 0.027和P = 0.016）。
氯胺酮与镁联合使用可减少脊柱侧弯手术后的术后吗啡消耗量。似乎能提供更好的睡眠质量并提高患者满意度。
