Jendoubi Ali, Naceur Imed Ben, Bouzouita Abderrazak, Trifa Mehdi, Ghedira Salma, Chebil Mohamed, Houissa Mohamed
Department of Anaesthesia and Intensive Care and Urology, Charles Nicolle Hospital of Tunis, Tunis, Tunisia.
Department of Anaesthesia and Intensive Care, Children Hospital of Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Saudi J Anaesth. 2017 Apr-Jun;11(2):177-184. doi: 10.4103/1658-354X.203027.
Recently, there has been increasing interest in the use of analgesic adjuncts such as intravenous (IV) ketamine and lidocaine.
To compare the effects of perioperative IV lidocaine and ketamine on morphine requirements, pain scores, quality of recovery, and chronic pain after open nephrectomy.
A prospective, randomized, placebo-controlled, double-blind trial.
The study was conducted in Charles Nicolle University Hospital of Tunis.
Sixty patients were randomly allocated to receive IV lidocaine: bolus of 1.5 mg/kg at the induction of anesthesia followed by infusion of 1 mg/kg/h intraoperatively and for 24 h postoperatively or ketamine: bolus of 0.15 mg/kg followed by infusion of 0.1 mg/kg/h intraoperatively and for 24 h postoperatively or an equal volume of saline (control group [CG]).
Morphine consumption, visual analog scale pain scores, time to the first passage of flatus and feces, postoperative nausea and vomiting (PONV), 6-min walk distance (6MWD) at discharge, and the incidence of chronic neuropathic pain using the "Neuropathic Pain Questionnaire" at 3 months.
Ketamine and lidocaine reduced significantly morphine consumption (by about 33% and 42%, respectively) and pain scores compared with the CG ( < 0.001). Lidocaine and ketamine also significantly improved bowel function in comparison to the CG ( < 0.001). Ketamine failed to reduce the incidence of PONV. The 6 MWD increased significantly from a mean ± standard deviation of 27 ± 16.2 m in the CG to 82.3 ± 28 m in the lidocaine group ( < 0.001). Lidocaine, but not ketamine, reduced significantly the development of neuropathic pain at 3 months ( < 0.05).
Ketamine and lidocaine are safe and effective adjuvants to decrease opioid consumption and control early pain. We also suggest that lidocaine infusion serves as an interesting alternative to improve the functional walking capacity and prevent chronic neuropathic pain at 3 months after open nephrectomy.
最近，人们对使用静脉注射氯胺酮和利多卡因等镇痛辅助药物的兴趣日益增加。
比较围手术期静脉注射利多卡因和氯胺酮对开放性肾切除术后吗啡需求量、疼痛评分、恢复质量和慢性疼痛的影响。
一项前瞻性、随机、安慰剂对照、双盲试验。
该研究在突尼斯的查尔斯·尼科勒大学医院进行。
60例患者被随机分配接受静脉注射利多卡因：麻醉诱导时静脉推注1.5mg/kg，术中及术后24小时持续输注1mg/kg/h；或氯胺酮：静脉推注0.15mg/kg，术中及术后24小时持续输注0.1mg/kg/h；或等体积生理盐水（对照组[CG]）。
吗啡用量、视觉模拟评分法疼痛评分、首次排气和排便时间、术后恶心呕吐（PONV）、出院时6分钟步行距离（6MWD），以及术后3个月使用“神经性疼痛问卷”评估慢性神经性疼痛的发生率。
与对照组相比，氯胺酮和利多卡因显著降低了吗啡用量（分别降低约33%和42%）和疼痛评分（P<0.001）。与对照组相比，利多卡因和氯胺酮也显著改善了肠道功能（P<0.001）。氯胺酮未能降低PONV的发生率。6MWD从对照组的平均±标准差27±16.2m显著增加到利多卡因组的82.3±28m（P<0.001）。利多卡因而非氯胺酮在术后3个月显著降低了神经性疼痛的发生率（P<0.05）。
氯胺酮和利多卡因是安全有效的辅助药物，可减少阿片类药物用量并控制早期疼痛。我们还建议，静脉输注利多卡因是一种有趣的替代方法，可提高开放性肾切除术后3个月的功能性步行能力并预防慢性神经性疼痛。
