Ragazzoni Luca, Kwizera Arthur, Caviglia Marta, Bodas Moran, Franc Jeffrey Michael, Ssemmanda Hannington, Ripoll-Gallardo Alba, Della-Corte Francesco, Alenyo-Ngabirano Annet
CRIMEDIM - Research Center in Emergency and Disaster Medicine, Università del Piemonte Orientale, Novara, Italy.
Department of Anaesthesia, Makerere University, Kampala, Uganda.
Afr Health Sci. 2019 Dec;19(4):3127-3135. doi: 10.4314/ahs.v19i4.35.
In developing countries, post-operative pain remains underestimated and undertreated due to economic constraints, lack of awareness and limited resources. In contrast, ketamine is an effective, readily available, easy to use and inexpensive drug frequently used in poor settings.
The aim of this study was to explore the overall reduction in the medication treatment cost of acute post-operative pain by adding intra-operative low-dose ketamine to traditional intravenous morphine for surgery in a low-income country.
A double blind randomized controlled trial with placebo-controlled parallel group was performed in Mulago National Hospital (Uganda). Consenting adults scheduled for elective surgery were randomized into two study arms: Group K received ketamine 0.15mg/kg bolus at induction and a continuous infusion of 0.12 mg/kg/hour till start of skin closure; Group C (control) received normal saline. Both groups received Morphine 0.1 mg/kg IV at debulking. The total medication cost was registered. NRS pain scores and other measurements such vital signs and incidence of major and minor side effects were also recorded.
A total of 46 patients were included. Patients' baseline characteristics were comparable in both groups. No statistically significant difference was found between the groups concerning the overall medication cost of post-operative pain management. Pain scores, patients' satisfaction in the first 24 hours after surgery and hospital length of stay were similar in both groups.
Our results do not support the utilization of intra-operative low dose ketamine as a cost-saving post-operative pain treatment strategy for all types of surgery in low-resource settings.
在发展中国家，由于经济限制、意识缺乏和资源有限，术后疼痛仍未得到充分重视和治疗。相比之下，氯胺酮是一种有效、易于获取、使用方便且价格低廉的药物，常用于资源匮乏地区。
本研究旨在探讨在低收入国家，通过在传统静脉注射吗啡基础上术中添加低剂量氯胺酮，来降低急性术后疼痛药物治疗成本的总体效果。
在穆拉戈国家医院（乌干达）进行了一项双盲随机对照试验，采用安慰剂对照平行组设计。同意参与的择期手术成年患者被随机分为两个研究组：K组在诱导时静脉推注0.15mg/kg氯胺酮，并持续输注0.12mg/kg/小时直至皮肤缝合开始；C组（对照组）输注生理盐水。两组在减瘤时均静脉注射0.1mg/kg吗啡。记录总药物成本。还记录了数字评分量表（NRS）疼痛评分以及其他指标，如生命体征、主要和次要副作用的发生率。
共纳入46例患者。两组患者的基线特征具有可比性。在术后疼痛管理的总体药物成本方面，两组之间未发现统计学显著差异。两组的疼痛评分、术后24小时内患者满意度和住院时间相似。
我们的研究结果不支持在资源匮乏地区将术中低剂量氯胺酮作为所有类型手术术后疼痛的成本节约治疗策略。
