Department of Anesthesiology, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Haidian District, #52 Fucheng Street, Beijing, 100142, China.
BMC Surg. 2023 Mar 30;23(1):74. doi: 10.1186/s12893-023-01973-0.
This prospective randomized controlled study was designed to evaluate the effect of S-ketamine with sufentanil given intraoperatively and postoperatively on recovery of gastrointestinal (GI) function and postoperative pain in gynecological patients undergoing open abdomen surgery.
One hundred gynecological patients undergoing open abdomen surgery were randomized into an S-ketamine group (group S) or placebo group (0.9% saline; group C). Anesthesia was maintained with S-ketamine, sevoflurane, and remifentanil-propofol target-controlled infusion in group S and with sevoflurane and remifentanil-propofol target-controlled infusion in group C. All patients were connected to patient-controlled intravenous analgesia (PCIA) pump at the end of the surgery with sufentanil, ketorolac tromethamine, and tropisetron in group C and additional S-ketamine in group S. The primary outcome was the time of first postoperative flatus, and the secondary outcome was postoperative pain score of patients. Postoperative sufentanil consumption within the first postoperative 24 h and adverse events such as nausea and vomiting were recorded.
The time of first postoperative flatus in group S was significantly shorter (mean ± SD, 50.3 ± 13.5 h) than that in group C (mean ± SD, 56.5 ± 14.3 h, p = 0.042). The patient's visual analog scale (VAS) pain score 24 h after surgery at rest was significantly lower in group S than in group C (p = 0.032). There were no differences in sufentanil consumption within the first postoperative 24 h, postoperative complications related to PCIA between the two groups.
S-ketamine accelerated postoperative GI recovery and reduced 24 h postoperative pain in patients undergoing open gynecological surgery.
ChiCTR2200055180. Registered on 02/01/2022. It is a secondary analysis of the same trial.
本前瞻性随机对照研究旨在评估术中及术后给予 S-氯胺酮和舒芬太尼对行开腹手术的妇科患者胃肠（GI）功能恢复和术后疼痛的影响。
100 例行开腹手术的妇科患者随机分为 S-氯胺酮组（S 组）或安慰剂组（0.9%生理盐水；C 组）。S 组采用 S-氯胺酮、七氟醚和瑞芬太尼-丙泊酚靶控输注维持麻醉，C 组采用七氟醚和瑞芬太尼-丙泊酚靶控输注维持麻醉。所有患者在手术结束时均连接患者自控静脉镇痛（PCIA）泵，C 组泵入舒芬太尼、酮咯酸氨丁三醇和托烷司琼，S 组泵入额外的 S-氯胺酮。主要结局是术后首次排气时间，次要结局是患者的术后疼痛评分。记录术后 24 小时内舒芬太尼的消耗量以及恶心和呕吐等不良反应。
S 组首次术后排气时间明显短于 C 组（均数±标准差，50.3±13.5 小时 vs. 56.5±14.3 小时，p=0.042）。S 组术后 24 小时静息时的视觉模拟评分（VAS）疼痛评分明显低于 C 组（p=0.032）。两组患者术后 24 小时内舒芬太尼消耗量、与 PCIA 相关的术后并发症无差异。
S-氯胺酮可加速妇科开腹手术后的胃肠恢复，并降低术后 24 小时的疼痛。
ChiCTR2200055180。于 2022 年 2 月 1 日注册。这是同一项试验的二次分析。
