Cairo University, National Cancer Institute, Cairo, Egypt.
Cairo University, National Cancer Institute, Cairo, Egypt.
Braz J Anesthesiol. 2023 Mar-Apr;73(2):165-170. doi: 10.1016/j.bjane.2021.07.015. Epub 2021 Jul 29.
Opioids are the cornerstone in managing postoperative pain; however, they have many side effects. Ketamine and Magnesium (Mg) are NMDA receptor antagonists used as adjuvant analgesics to decrease postoperative opioid consumption.
We assumed that adding Mg to ketamine infusion can improve the intraoperative and postoperative analgesic efficacy of ketamine infusion alone in cancer breast surgeries.
Ninety patients aged between 18 and 65 years and undergoing elective cancer breast surgery were included in this prospective randomized, double-blind study. Group K received ketamine 0.5.ßmg.kg bolus then 0.12.ßmg.kg.h infusion for the first 24.ßhours postoperatively. Group KM: received ketamine 0.5.ßmg.kg and Mg sulfate 50.ßmg.kg, then ketamine 0.12.ßmg.kg.h and Mg sulfate 8.ßmg.kg.h infusions for the first 24.ßhours postoperative. The primary outcome was the morphine consumption in the first 24.ßhours postoperative, while the secondary outcomes were: intraoperative fentanyl consumption, NRS, side effects, and chronic postoperative pain.
Group KM had less postoperative opioid consumption (14.12.ß...ß5.11.ßmg) than Group K (19.43.ß...ß6.8.ßmg). Also, Group KM had less intraoperative fentanyl consumption. Both groups were similar in postoperative NRS scores, the incidence of side effects related to opioids, and chronic neuropathic pain.
Adding Mg to ketamine infusion can safely improve intraoperative and postoperative analgesia with opioid-sparing effect in cancer breast surgery.
阿片类药物是管理术后疼痛的基石；然而，它们有许多副作用。氯胺酮和镁（Mg）是 NMDA 受体拮抗剂，用作辅助镇痛药以减少术后阿片类药物的消耗。
我们假设在乳腺癌手术中，将 Mg 添加到氯胺酮输注中可以提高氯胺酮单独输注的术中及术后镇痛效果。
本前瞻性随机双盲研究纳入了 90 名年龄在 18 至 65 岁之间、接受择期乳腺癌手术的患者。K 组接受氯胺酮 0.5mg/kg 推注，然后在术后 24 小时内输注 0.12mg/kg/h。KM 组：给予氯胺酮 0.5mg/kg 和硫酸镁 50mg/kg，然后在术后 24 小时内输注氯胺酮 0.12mg/kg/h 和硫酸镁 8mg/kg/h。主要观察指标是术后 24 小时内吗啡的消耗量，次要观察指标包括：术中芬太尼的消耗量、NRS 评分、不良反应和慢性术后疼痛。
与 K 组（19.43mg/kg）相比，KM 组术后阿片类药物消耗较少（14.12mg/kg）。KM 组术中芬太尼消耗量也较少。两组术后 NRS 评分、与阿片类药物相关的不良反应发生率和慢性神经性疼痛发生率均相似。
在乳腺癌手术中，将 Mg 添加到氯胺酮输注中可以安全地提高术中及术后镇痛效果，减少阿片类药物的使用。
