Lee Jiwon, Park Hee-Pyoung, Jeong Mu-Hui, Son Je-Do, Kim Hyun-Chang
1 Department of Anaesthesiology and Pain Medicine, Keimyung University Dongsan Medical Centre, Daegu, Korea.
2 Department of Anaesthesiology and Pain Medicine, Seoul National University, Seoul, Korea.
J Int Med Res. 2018 Mar;46(3):1109-1120. doi: 10.1177/0300060517734679. Epub 2017 Nov 10.
Objective Although robotic thyroidectomy (RoT) is a minimally invasive surgery, percutaneous tunneling causes moderate to severe pain immediately postoperatively. We evaluated the efficacy of ketamine for postoperative pain management in patients following RoT. Methods Sixty-four patients scheduled for RoT were randomly divided into two groups. In the ketamine group (n = 32), ketamine was infused from induction of anaesthesia until the end of the procedure (0.15-mg/kg bolus with continuous infusion at 2 µg/kg/min). In the control group (n = 32), the same volume of saline was infused. Visual analogue scale (VAS) scores for acute and chronic pain, the incidence of hypoesthesia, postoperative analgesic requirements, and complications related to opioids or ketamine were compared between the two groups. Results The VAS pain scores were significantly lower in the ketamine group up to 24 h postoperatively. The VAS pain score when coughing was significantly higher in the control group than in the ketamine group at 24 h postoperatively. A significantly greater proportion of patients in the control group required rescue analgesics. Complications were comparable in both groups. Conclusions Ketamine infusion decreased pain scores for 24 h postoperatively and reduced analgesic requirements without serious complications in patients following RoT.
Clinicaltrials.gov Identifier: NCT01997801.
目的 尽管机器人甲状腺切除术(RoT)是一种微创手术,但经皮隧道会在术后立即引起中度至重度疼痛。我们评估了氯胺酮对RoT术后患者疼痛管理的疗效。方法 将64例计划行RoT的患者随机分为两组。氯胺酮组(n = 32)从麻醉诱导开始至手术结束持续输注氯胺酮(0.15 mg/kg静脉推注,随后以2 μg/kg/min持续输注)。对照组(n = 32)输注相同体积的生理盐水。比较两组患者急性和慢性疼痛的视觉模拟量表(VAS)评分、感觉减退的发生率、术后镇痛需求以及与阿片类药物或氯胺酮相关的并发症。结果 氯胺酮组术后24小时内的VAS疼痛评分显著更低。术后24小时,对照组咳嗽时的VAS疼痛评分显著高于氯胺酮组。对照组需要急救镇痛的患者比例显著更高。两组并发症发生率相当。结论 输注氯胺酮可降低RoT术后患者术后24小时的疼痛评分,减少镇痛需求,且无严重并发症。
Clinicaltrials.gov标识符:NCT01997801。