Department of Anesthesiology & Critical Care, All India Institute of Medical Sciences, Bhubaneswar, India.
Department of Pharmacology, All India Institute of Medical Sciences, Bhubaneswar, India.
Korean J Anesthesiol. 2022 Apr;75(2):178-184. doi: 10.4097/kja.21373. Epub 2021 Nov 4.
Subanesthetic intravenous (IV) ketamine acts as an analgesic and has opioid-sparing effects, particularly for acute postoperative pain; however, its effectiveness in children is understudied. The primary aim of this study was to evaluate the non-inferiority of subanesthetic IV ketamine vs. caudal bupivacaine for postoperative analgesia in children undergoing infraumbilical surgery.
Children aged < 6 years were enrolled in this single-blind study and randomized to receive either subanesthetic IV ketamine (0.3 mg/kg) or caudal 0.125% bupivacaine (1 ml/kg) along with general anesthesia. Postoperative pain was assessed using the FLACC scale at 30 minutes and 1, 2, 3, and 6 h post-operation. Intra- and postoperative opioid consumption, time to extubation, postoperative vomiting, agitation, sedation, and inflammatory markers were also assessed.
Altogether, 141 children completed the study (ketamine group: n = 71, caudal group: n = 70) The cumulative proportion of children without significant postoperative pain (FLACC score < 4) in the first 6 h post-surgery was 45.1% in the ketamine group vs. 72.9% in the caudal group (P < 0.001). More children in the ketamine group required an additional dose of intraoperative fentanyl (33.8% vs. 5.7%, P < 0.001) and postoperative tramadol (54.9% vs. 27.1%, P < 0.001). However, postoperative agitation, sedation, and other secondary outcomes were similar between the groups.
Subanesthetic ketamine is inferior to caudal bupivacaine for postoperative analgesia in children aged < 6 years undergoing infra-umbilical surgeries; however, other postoperative outcomes are similar.
亚麻醉剂量的静脉注射（IV）氯胺酮具有镇痛作用，并具有阿片类药物节约作用，尤其适用于急性术后疼痛；然而，其在儿童中的有效性研究较少。本研究的主要目的是评估亚麻醉剂量 IV 氯胺酮与骶管布比卡因在小儿下腹部手术中的术后镇痛效果。
本单盲研究纳入了年龄<6 岁的儿童，并随机分为接受亚麻醉剂量 IV 氯胺酮（0.3mg/kg）或骶管 0.125%布比卡因（1ml/kg）加全身麻醉的两组。术后 30 分钟和 1、2、3、6 小时使用 FLACC 量表评估术后疼痛。还评估了术中及术后阿片类药物的使用、拔管时间、术后呕吐、躁动、镇静和炎症标志物。
共有 141 名儿童完成了研究（氯胺酮组：n=71，骶管组：n=70）。术后 6 小时内无明显疼痛（FLACC 评分<4）的儿童比例在氯胺酮组为 45.1%，在骶管组为 72.9%（P<0.001）。氯胺酮组有更多的儿童需要术中额外给予芬太尼（33.8% vs. 5.7%，P<0.001）和术后曲马多（54.9% vs. 27.1%，P<0.001）。然而，两组间术后躁动、镇静等其他次要结局相似。
亚麻醉剂量氯胺酮在<6 岁行下腹部手术的儿童中的术后镇痛效果不如骶管布比卡因，但其他术后结局相似。
