Department of Anesthesia, University of Saskatchewan, Saskatoon, SK, Canada.
Department of Anesthesiology, University of Rwanda, Kigali, Rwanda.
Can J Anaesth. 2018 Feb;65(2):170-177. doi: 10.1007/s12630-017-1009-7. Epub 2017 Nov 13.
Postoperative pain control is often inadequate in low-income countries such as Rwanda, prompting the search for an inexpensive improvement. A randomized controlled trial was conducted to study the use of subcutaneous ketamine for the management of postoperative pain in patients undergoing major surgery in Kigali, Rwanda.
Fifty-nine patients undergoing major abdominal, head and neck, plastic, or gynecological surgeries were studied. In addition to standard care, patients received five subcutaneous injections of ketamine 1 mg·kg (ketamine group, n = 30) or normal saline (placebo group, n = 29) during the postoperative period. The first injection was administered in the postanesthesia care unit and then every 12 hr thereafter starting at 20:00 on the day of surgery. Pain was assessed three times per day using an 11-point verbal response scale. Patients were also assessed for side effects, including nausea and vomiting, hallucinations, nightmares, sedation, hypertension, and seizures.
The mean (SD) overall postoperative pain scale score was higher in the control group than in the ketamine group [4.8 (1.7) vs 3.7 (1.5), respectively; difference of means, 1.1; 95% confidence interval [CI], 0.3 to 1.9; P = 0.009]. Brief hallucinations (ketamine group, 11 patients; placebo group, 0 patients; risk difference, 0.37; 95% CI, 0.18 to 0.54; P < 0.001) were associated with ketamine administration.
Results of this study in Kigali, Rwanda showed that subcutaneous administration of ketamine 1 mg·kg twice daily, in addition to standard postoperative care, produced a small improvement in postoperative pain but resulted in more minor side effects TRIAL REGISTRATION: www.clinicaltrials.gov (NCT02514122). Registered 31 July 2015.
在卢旺达等低收入国家，术后疼痛控制往往不够充分，因此需要寻找一种廉价的改进方法。本研究进行了一项随机对照试验，以研究在卢旺达基加利接受大型手术的患者中，使用皮下注射氯胺酮来管理术后疼痛。
研究纳入了 59 名接受大型腹部、头颈部、整形或妇科手术的患者。除了标准护理外，患者在术后期间还接受了五次皮下注射氯胺酮 1mg·kg（氯胺酮组，n=30）或生理盐水（安慰剂组，n=29）。第一次注射在麻醉后护理病房进行，然后从手术当天 20:00 开始，每 12 小时注射一次。每天使用 11 点言语反应量表评估三次疼痛。还评估了患者的副作用，包括恶心和呕吐、幻觉、噩梦、镇静、高血压和癫痫发作。
对照组的总体术后疼痛量表评分高于氯胺酮组[分别为 4.8（1.7）和 3.7（1.5）；平均差异，1.1；95%置信区间[CI]，0.3 至 1.9；P=0.009]。短暂幻觉（氯胺酮组 11 例，安慰剂组 0 例；风险差异，0.37；95%CI，0.18 至 0.54；P<0.001）与氯胺酮给药有关。
本研究在卢旺达基加利的结果表明，每日两次皮下注射氯胺酮 1mg·kg，除了标准术后护理外，还可使术后疼痛略有改善，但会导致更多轻微的副作用。试验注册：www.clinicaltrials.gov（NCT02514122）。2015 年 7 月 31 日注册。
