Department of Anesthesia, University of Saskatchewan, Saskatoon, SK, Canada.
Department of Anesthesia, University of Rwanda, College of Medicine and Health Sciences, Butare, Rwanda.
Can J Anaesth. 2017 Sep;64(9):928-934. doi: 10.1007/s12630-017-0914-0. Epub 2017 Jun 19.
Good pain control is not a normal part of surgical care in sub-Saharan Africa due to lack of resources. The primary objective of this study was to determine an efficacious dose of subcutaneous ketamine for postoperative pain for use in a future randomized controlled trial.
Following research ethics board and local hospital approval for this research, we obtained informed consent from 31 patients undergoing major surgery for a random walk dose-finding study. In addition to standard postoperative care, participants received five doses of subcutaneous ketamine at scheduled intervals from arrival in the postanesthesia care unit (PACU) to postoperative day 2. Participants received 50 mg of ketamine (minimum 0.6 to maximum 1.1 mg·kg, based on different body weights) for the first and second dose, with subsequent doses adjusted by 10 mg according to pain and side effects. Pain scores were recorded at rest and with movement.
The following mean (standard deviation [SD]) pain scores at rest and with movement were recorded on arrival in the PACU and on the afternoon of postoperative days 1 and 2: [at rest: 8.2 (1.5), 3.2 (1.8), and 0.7 (1.0), respectively; with movement: 9.4 (0.8), 5.1 (1.7), and 2.4 (1.1), respectively]. This rate of improvement suggests possible pain relief through use of ketamine. The mean (SD) ketamine dose that appeared efficacious in pain reduction was 0.90 (0.23) mg·kg. There were no serious side effects.
Adding subcutaneous ketamine to standard analgesic measures resulted in decreases in postoperative pain scores without serious side effects. These data can be used to inform a randomized controlled trial to compare subcutaneous ketamine plus standard care with placebo plus standard care for reducing postoperative pain.
由于资源匮乏，在撒哈拉以南非洲地区，良好的疼痛控制并不是外科护理的常规内容。本研究的主要目的是确定术后疼痛中皮下给予氯胺酮的有效剂量，以便用于未来的随机对照试验。
本项研究获得了研究伦理委员会和当地医院的批准，并获得了 31 名接受大型手术的患者的知情同意，进行了一项随机游走剂量发现研究。除了标准的术后护理外，参与者在到达麻醉后监护病房（PACU）到术后第 2 天的预定时间间隔内接受五次皮下给予氯胺酮。参与者接受了 50mg 的氯胺酮（根据不同体重，最低 0.6mg·kg，最高 1.1mg·kg），第 1 次和第 2 次剂量为 50mg，随后根据疼痛和副作用调整剂量 10mg。记录休息时和运动时的疼痛评分。
在 PACU 到达时以及术后第 1 天和第 2 天的下午，记录了以下平均（标准差 [SD]）休息时和运动时的疼痛评分：[休息时：8.2（1.5）、3.2（1.8）和 0.7（1.0）；运动时：9.4（0.8）、5.1（1.7）和 2.4（1.1）]。这种改善速度表明氯胺酮的使用可能缓解了疼痛。在减少疼痛方面似乎有效的平均（SD）氯胺酮剂量为 0.90（0.23）mg·kg。没有严重的副作用。
在标准镇痛措施的基础上，皮下给予氯胺酮可降低术后疼痛评分，且无严重副作用。这些数据可用于为一项随机对照试验提供信息，比较氯胺酮加标准护理与安慰剂加标准护理对减少术后疼痛的效果。
