Pereira Helder, Graça Maria Inês, Fonseca Diana, Mendes-Castro Alfredo, Abelha Fernando
Department of Surgery and Physiology-Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, Porto, Portugal.
Anaesthesia Department, Centro Hospitalar Universitário de São João, Alameda Professor Hernâni Monteiro, Porto, Portugal.
Anesthesiol Res Pract. 2023 Jan 20;2023:8890025. doi: 10.1155/2023/8890025. eCollection 2023.
The quality of recovery is a cluster of patient-related outcomes that emphasise not only pain but different physical and emotional dimensions. Traditionally, ketamine is used to improve postoperative analgesia and avoid opioid consumption and opioid-related side effects.
The present study sought to evaluate if intraoperative ketamine administration (as a part of multimodal analgesia) influences the quality of recovery after laparoscopic surgery.
A prospective two-armed, single-blinded trial. . Tertiary single-centre trial between July 2021 and January 2022. . From the 146 patients initially admitted to the study, 127 patients were enrolled, 60 in the ketamine group (group K) and 67 in the control group (group NK). . Both groups received a rigid intraoperative anaesthesia protocol; furthermore, in group K, 0.5 mg/kg of the ideal body weight of ketamine was administered. . The primary outcome was to evaluate the effect of ketamine administration on the postoperative quality of recovery using the Portuguese version of the Quality of Recovery-15 (QoR-15) Questionnaire 24 h after surgery. The total score and minimal clinically significant difference (MCID) of the QoR-15 were compared. Other variables were also assessed such as the presence of emergence delirium (ED), the Numeric Rating Scale (NRS) for pain, and the presence of postoperative nausea and vomiting (PONV).
A total of 127 patients were allocated to the study groups, 60 in group K and 67 in group NK. Regarding the primary outcome, no differences were found in individual categories (15 items) and in the total score of QoR-15 (=0.214). Concerning improvement (MCID ≥ 8) or worsening (MCID ≤ 8) in quality of recovery, no difference was found between the groups (24 vs. 32 and 6 vs. 6; =0.776). Finally, no difference was found in secondary postoperative outcomes including ED (=0.55), NRS (=0.401), and PONV (=0.55).
In this study, the administration of ketamine in laparoscopic surgery had no impact on the quality of recovery 24 h after surgery. This trial is registered with NCT03724019.
恢复质量是一组与患者相关的结果，不仅强调疼痛，还包括不同的身体和情感维度。传统上，氯胺酮用于改善术后镇痛，避免使用阿片类药物及其相关副作用。
本研究旨在评估术中给予氯胺酮（作为多模式镇痛的一部分）是否会影响腹腔镜手术后的恢复质量。
一项前瞻性双臂单盲试验。2021年7月至2022年1月在三级单中心进行。最初纳入研究的146例患者中，127例患者被纳入，氯胺酮组（K组）60例，对照组（NK组）67例。两组均接受严格的术中麻醉方案；此外，K组给予理想体重0.5mg/kg的氯胺酮。主要结局是使用葡萄牙语版的术后恢复质量-15（QoR-15）问卷在术后24小时评估氯胺酮给药对术后恢复质量的影响。比较QoR-15的总分和最小临床显著差异（MCID）。还评估了其他变量，如苏醒谵妄（ED）的发生情况、疼痛数字评分量表（NRS）以及术后恶心呕吐（PONV）的发生情况。
共有127例患者被分配到研究组，K组60例，NK组67例。关于主要结局，在各个类别（15项）和QoR-15总分方面未发现差异（P=0.214）。关于恢复质量的改善（MCID≥8）或恶化（MCID≤8），两组之间未发现差异（24对32以及6对6；P=0.776）。最后，在包括ED（P=0.55）、NRS（P=0.401）和PONV（P=0.55）在内的术后次要结局方面未发现差异。
在本研究中，腹腔镜手术中给予氯胺酮对术后24小时的恢复质量没有影响。本试验已在ClinicalTrials.gov注册，注册号为NCT03724019。
