Schotola Hanna, Kirsch Karl-Christian, Höcker Jan, Egan Michael, Büttner Benedikt, Wiese Christoph, Mansur Ashham, Hinz José Maria, Bergmann Ingo
Department of Anaesthesiology, Emergency and Intensive Care Medicine, University of Göttingen Medical School, Göttingen, Germany.
Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Open Med (Wars). 2015 May 28;10(1):297-305. doi: 10.1515/med-2015-0043. eCollection 2015.
Pain after arthroscopic shoulder surgery is often severe, and establishing a pain treatment regimen that does not delay discharge can be challenging. The reported ability of ketamine to prevent opioid-induced hyperalgesia has not been investigated in this particular setting.
300 adult patients scheduled for shoulder arthroscopy under general anesthesia were recruited for this observational clinical trial and were allotted to either receive 1mg/kg IV bolus of ketamine before surgery (ketamine group, KG) or to a control group (CG) without ketamine. NRS pain scores were obtained on the operative day and on postoperative days 1 and 2 and compared between groups. Secondary variables were blood pressure, heart rate, process times, satisfaction with the anesthetic and unwanted effects.
Pain severity did not differ significantly between the groups at any time. Propofol injection rate and cumulative dose were higher in the KG. Heart rates and blood pressures were similar. Time to emergence and time in PACU were longer and vomiting was more frequent in patients given ketamine.
Preoperative low-dose ketamine added to a general anesthetic does not reduce perioperative pain after outpatient shoulder arthroscopy. It increases procedural times and the incidence of PONV.
关节镜下肩部手术后疼痛通常较为严重，制定一种不延迟出院的疼痛治疗方案具有挑战性。氯胺酮预防阿片类药物引起的痛觉过敏的能力在这种特定情况下尚未得到研究。
300例计划在全身麻醉下行肩关节镜检查的成年患者被纳入这项观察性临床试验，并被分配接受术前静脉注射1mg/kg氯胺酮（氯胺酮组，KG）或不接受氯胺酮的对照组（CG）。在手术当天以及术后第1天和第2天获得数字疼痛评分量表（NRS）疼痛评分，并在组间进行比较。次要变量包括血压、心率、手术时间、对麻醉的满意度和不良反应。
两组在任何时候的疼痛严重程度均无显著差异。氯胺酮组丙泊酚注射速率和累积剂量更高。心率和血压相似。使用氯胺酮的患者苏醒时间和在麻醉后护理单元（PACU）的时间更长，呕吐更频繁。
在全身麻醉中添加术前低剂量氯胺酮并不能减轻门诊肩关节镜检查后的围手术期疼痛。它会增加手术时间和术后恶心呕吐（PONV）的发生率。
