Küçük Onur, Sarı Esra, Zengin Musa, Ülger Gülay, Öztürk Yalçın Fatma, Baldemir Ramazan, Tunç Mehtap, Alagöz Ali
Department of Anesthesiology and Reanimation, Ankara Atatürk Sanatoryum Training and Research Hospital, University of Health Sciences, 06290 Ankara, Turkey.
Department of Anesthesiology and Reanimation, Ankara Etlik City Hospital, Ministry of Health, 06170 Ankara, Turkey.
Medicina (Kaunas). 2024 Apr 22;60(4):679. doi: 10.3390/medicina60040679.
: Thoracic epidural catheterization (TEC) can be both uncomfortable and fearful for patients when performed awake with the thought that the procedure may be painful. The aim of this study was to assess the effect of low-dose intravenous ketamine administration on pain and anxiety during the TEC procedure. : Sixty patients were randomly divided into two groups to receive intravenous (IV) placebo (Group P) and IV low-dose (0.15 mg/kg) ketamine (LDK) (Group K) 3 min before the procedure in a double-blind manner. A visual analog scale (VAS) was used to measure anxiety (VAS-A) and pain (VAS-P) scores. Vital parameters were monitored before premedication (T1), 20 min after premedication (T2), during skin anesthesia (T3), during TEC (T4), and 5 min after TEC (T5). VAS-A values were recorded at T1, T3, T4, and T5 periods, and VAS-P levels were noted at T3, T4, and T5 periods. : During TEC (T4), both VAS-P and VAS-A were significantly lower in Group K ( < 0.001). The mean VAS-A value was 10.6 mm lower, and the mean VAS-P value was 9 mm lower in Group K than in Group P at the T4 time point. Additionally, the mean VAS-P value was 7.7 mm lower in Group K compared to Group P at the T3 time point ( < 0.001). Both groups showed a statistically significant difference in VAS-A measurements when compared at their respective time points ( < 0.001). However, only Group P demonstrated a statistically significant difference in VAS-P measurements ( < 0.001). VAS-P values remained stable in Group K. The number of patients who did not recall the procedure was significantly higher in Group K ( < 0.001). Furthermore, the number of patients who would consent to the same procedure in the future was significantly higher in Group K ( = 0.007). : A preprocedural LDK (0.15 mg/kg) can effectively prevent anxiety and pain experienced by patients during the TEC procedure. Administration of LDK may provide a more comfortable procedure process without causing ketamine-induced side effects (hemodynamic, respiratory, and psychological).
对于清醒状态下接受胸椎硬膜外导管置入术（TEC）的患者而言，想到该操作可能带来疼痛，他们会感到不适和恐惧。本研究的目的是评估术前静脉注射小剂量氯胺酮对TEC操作过程中疼痛和焦虑的影响。
60例患者被随机分为两组，在操作前3分钟以双盲方式分别静脉注射（IV）安慰剂（P组）和IV小剂量（0.15mg/kg）氯胺酮（LDK）（K组）。采用视觉模拟量表（VAS）测量焦虑（VAS-A）和疼痛（VAS-P）评分。在术前用药前（T1）、术前用药后20分钟（T2）、皮肤麻醉期间（T3）、TEC操作期间（T4）以及TEC操作后5分钟（T5）监测生命体征参数。在T1、T3、T4和T5时间段记录VAS-A值，在T3、T4和T5时间段记录VAS-P水平。
在TEC操作期间（T4），K组的VAS-P和VAS-A均显著更低（<0.001）。在T4时间点，K组的平均VAS-A值比P组低10.6mm，平均VAS-P值比P组低9mm。此外，在T3时间点，K组的平均VAS-P值比P组低7.7mm（<0.001）。两组在各自时间点比较VAS-A测量值时均显示出统计学显著差异（<0.001）。然而，只有P组在VAS-P测量值上显示出统计学显著差异（<0.001）。K组的VAS-P值保持稳定。K组中对操作无回忆的患者数量显著更多（<0.001）。此外，K组中未来愿意同意进行相同操作的患者数量显著更多（=0.007）。
术前给予LDK（0.15mg/kg）可有效预防患者在TEC操作过程中经历的焦虑和疼痛。给予LDK可提供更舒适的操作过程，且不会引起氯胺酮诱导的副作用（血流动力学、呼吸和心理方面）。
