Fahad Najam M, Jafri Nusrat
Anaesthesiology, Abbasi Shaheed Hospital, Karachi, PAK.
Cureus. 2022 Jul 4;14(7):e26563. doi: 10.7759/cureus.26563. eCollection 2022 Jul.
Background and objective In light of the scarcity of data and research about the management of pain in a low-resource setting, we conducted this study with a view to assessing the effectiveness of intravenous ketamine in comparison to that of intradermal lidocaine in reducing postoperative pain. Postoperative pain can lead to significant morbidity, longer hospital stay, and the development of chronic pain. Our study was formulated to assess the effectiveness of a ketamine bolus in comparison to intradermal lidocaine at the wound site in terms of decreasing pain scores postoperatively. Methods In our study, 99 patients were randomly selected to undergo inguinal hernia repair under spinal anesthesia. After obtaining informed consent from the participants and approval from the hospital ethical committee, the patients were randomly classified into the following three groups: the lidocaine group (group A), the ketamine group (group B), and the control group (group C). The patients in the lidocaine group received 0.6 mL/kg of 0.25% lidocaine (1.5 mg/kg) infiltration at the wound site. The ketamine group was given a 50-mg ketamine bolus at the end of the operation, and the control group did not receive either ketamine or intradermal lidocaine at the wound site. Postoperative pain was recorded using the Visual Analog Scale (VAS) scoring and the results were compared. The time of the first request for analgesia was also recorded. Results The pain scores measured via VAS scores were higher in patients who received intradermal lidocaine (group A) at the wound site as compared to group B that received a bolus of 50-mg ketamine (p<0.0001); the control group (group C) had pain scores higher than both groups A and B (p=0.0001). Conclusion Based on our findings, administering ketamine bolus can significantly decrease VAS scores and reduce the incidence of chronic post-surgical pain as compared to lidocaine infiltration. Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, provides excellent pain relief and analgesia, which decreases overall pain scores.
背景与目的 鉴于在资源匮乏环境下关于疼痛管理的数据和研究稀缺，我们开展了本研究，旨在评估静脉注射氯胺酮与皮内注射利多卡因相比在减轻术后疼痛方面的有效性。术后疼痛可导致显著的发病率、更长的住院时间以及慢性疼痛的发生。我们的研究旨在评估在伤口部位注射氯胺酮推注与皮内注射利多卡因相比在降低术后疼痛评分方面的有效性。方法 在我们的研究中，99例患者被随机选择在脊髓麻醉下接受腹股沟疝修补术。在获得参与者的知情同意并得到医院伦理委员会的批准后，患者被随机分为以下三组：利多卡因组（A组）、氯胺酮组（B组）和对照组（C组）。利多卡因组患者在伤口部位接受0.6 mL/kg的0.25%利多卡因（1.5 mg/kg）浸润。氯胺酮组在手术结束时给予50 mg氯胺酮推注，对照组在伤口部位既未接受氯胺酮也未接受皮内注射利多卡因。使用视觉模拟评分法（VAS）记录术后疼痛情况并比较结果。还记录了首次要求镇痛的时间。结果 与接受50 mg氯胺酮推注的B组相比，在伤口部位接受皮内注射利多卡因的患者（A组）通过VAS评分测量的疼痛评分更高（p<0.0001）；对照组（C组）的疼痛评分高于A组和B组（p=0.0001）。结论 根据我们的研究结果，与利多卡因浸润相比，给予氯胺酮推注可显著降低VAS评分并降低慢性术后疼痛的发生率。氯胺酮作为一种N-甲基-D-天冬氨酸（NMDA）受体拮抗剂，可提供出色的疼痛缓解和镇痛效果，从而降低总体疼痛评分。
