Haliloglu Murat, Ozdemir Mehtap, Uzture Neslihan, Cenksoy Pinar Ozcan, Bakan Nurten
a Department of Anaesthesiology and Reanimation , Yeditepe University Faculty of Medicine , İstanbul , Turkey .
b Department of Anaesthesiology and Reanimation , Umraniye education and Research Hospital , İstanbul , Turkey , and.
J Matern Fetal Neonatal Med. 2016 Mar;29(6):962-6. doi: 10.3109/14767058.2015.1027190. Epub 2015 Sep 25.
In this study, the effect of perioperative uses of low dose ketamine on post-operative wound pain and analgesic consumption in patients undergoing elective Cesarean section was evaluated.
In randomized, double blind clinical trial, 52 women with American Society of Anesthesiologists (ASA) class I-II identification undergoing elective Cesarean section in general anesthesia were enrolled. In the ketamine group (group K), a ketamine bolus of 0.5 mg kg(-1) IV was administered at the time of induction of general anesthesia. After induction, a ketamine infusion of 0.25 mg kg(-1) h(-1) was started and discontinued at the end of surgery. Patients allocated to the control group (group C) were given identical volumes of saline. The cumulative dose of morphine consumption after surgery was measured as the primary outcome of this study. Secondary outcomes were pain control assessed by numeric rating scale (NRS) and need for rescue analgesia and incidence of side effects.
The mean 24-h morphine consumption was lower in group K (p = 0,001). At 15 min postoperatively, NRS values were lower in group K than group C (p = 0,001). There was no difference among groups regarding the need for supplemental analgesia (rescue diclofenac doses) (p > 0.05).
Perioperative uses of low dose ketamine decreased post-operative opioid requirements, which was observed long after the normal expected duration of ketamine.
本研究评估了围手术期使用低剂量氯胺酮对择期剖宫产患者术后伤口疼痛及镇痛药物用量的影响。
在一项随机、双盲临床试验中，纳入了52例美国麻醉医师协会（ASA）分级为I-II级、接受全身麻醉下择期剖宫产的女性患者。氯胺酮组（K组）在全身麻醉诱导时静脉注射0.5 mg/kg的氯胺酮推注量。诱导后，开始以0.25 mg·kg⁻¹·h⁻¹的速度输注氯胺酮，并在手术结束时停止。分配至对照组（C组）的患者给予相同体积的生理盐水。术后吗啡的累积用量作为本研究的主要结局指标进行测量。次要结局指标包括采用数字评分量表（NRS）评估的疼痛控制情况、急救镇痛的需求以及副作用的发生率。
K组术后24小时的平均吗啡用量较低（p = 0.001）。术后15分钟时，K组的NRS值低于C组（p = 0.001）。在补充镇痛（双氯芬酸急救剂量）的需求方面，各组之间无差异（p > 0.05）。
围手术期使用低剂量氯胺酮可降低术后阿片类药物的需求量，且在氯胺酮正常预期作用时间后很长时间仍可观察到这一效果。
