Penn State Hershey Medical Center, Department of Anesthesiology and Perioperative Medicine, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, United States of America.
The Queen Elizabeth Hospital, Department of Anaesthesia, The University of Adelaide, Woodville South, SA 5011, Australia.
J Clin Anesth. 2021 Feb;68:110097. doi: 10.1016/j.jclinane.2020.110097. Epub 2020 Oct 23.
Background Ketamine and magnesium are antagonists of the N-methyl-d-aspartate receptor, and are valuable adjuvants for multimodal analgesia and opioid sparing. Data are limited regarding the opioid sparing efficacy of the combined intraoperative application of these agents in laparoscopic bariatric surgery. The objective of this study was to compare the postoperative opioid sparing properties of a single intraoperative dose of ketamine versus a combination of single doses of ketamine and magnesium after laparoscopic gastric sleeve resection in bariatric patients. Methods One hundred and twenty- six patients were randomly assigned to receive single boluses of ketamine alone 0.5 mg kg IV (ketamine group); combined ketamine bolus of 0.5 mg kg IV and magnesium 2 g IV (ketamine and magnesium group); or placebo. Opioid consumption at 24 h (in morphine equivalents); pain at rest; postoperative nausea and vomiting impact score; sedation scores; and trends of transcutaneous carbon-di-oxide values were analysed. Results The median (inter-quartile range [range]) morphine consumption at 24 h were 32 (24-47 [4.8-91]) mg in the ketamine group, 37 (18-53 [1-144]) mg in the ketamine and magnesium group, and 26 (21-36 [5-89]) mg in the control group and were not significantly different between the groups. There were no differences for all other outcomes examined. Conclusion Combined single intraoperative bolus doses of ketamine and magnesium did not result in postoperative opioid sparing after laparoscopic gastric sleeve resection.
氯胺酮和镁是 N-甲基-D-天冬氨酸受体的拮抗剂，是多模式镇痛和减少阿片类药物的有效辅助剂。关于这些药物联合应用于腹腔镜减重手术时对阿片类药物的节省效果的数据有限。本研究的目的是比较腹腔镜胃袖状切除术中单次应用氯胺酮与氯胺酮和镁单次剂量联合应用对术后阿片类药物节省的效果。
126 名患者被随机分配接受单剂量氯胺酮 0.5mg/kg 静脉推注（氯胺酮组）；氯胺酮 0.5mg/kg 静脉推注联合镁 2g 静脉推注（氯胺酮和镁组）；或安慰剂。分析术后 24 小时的阿片类药物消耗（以吗啡当量表示）；静息时的疼痛；术后恶心和呕吐影响评分；镇静评分；以及经皮二氧化碳值的趋势。
氯胺酮组术后 24 小时吗啡消耗量的中位数（四分位距[范围]）为 32（24-47 [4.8-91]）mg，氯胺酮和镁组为 37（18-53 [1-144]）mg，对照组为 26（21-36 [5-89]）mg，组间差异无统计学意义。其他所有结果均无差异。
腹腔镜胃袖状切除术后，单次联合应用氯胺酮和镁的单次推注剂量并不能节省术后阿片类药物。
