Bakhtiari Elham, Dori Mehrdad Mokaram, Razavi Millad Reza Darban, Yazdi Andia Peivandi, Yazdi Arash Peivandi
Clinical Research Development Unit, Mashhad University of Medical Sciences, Mashhad, Iran.
Department of Anesthesia, School of Medicine, Mashhad University of Medical Seince, Mashhad, Iran.
Anesth Pain Med (Seoul). 2024 Jul;19(3):209-215. doi: 10.17085/apm.23129. Epub 2024 Jul 31.
Postoperative pain can lead to several complications. The effectiveness of different opioids in relieving pain after surgery has been widely studied. However, managing pain in patients with opioid addiction is still challenging. This study aimed to examine the impact of ketamine and methadone on postoperative pain in patients with addiction.
This was a non-inferiority randomized clinical trial. All included patients were monitored for morphine use, pain scores, and vital signs every 3 h. The intervention group received 0.5 mg/kg ketamine administered intravenously every 6 h. The control group received 5 mg of methadone intramuscularly every 8 h. The patient received intravenous morphine if their visual analog scale was above 3. All side effects in each group were recorded.
Two hundred and twenty patients were included in this study. There were 127 men (57.7%) with an average age of 57.1 ± 19.5 and 93 women (42.3%) with an average age of 57.1 ± 21.0. There were no significant differences in demographic characteristics between the groups. There was no significant difference in the dose or frequency of morphine administration between groups. There was no significant difference between the groups in pain scores and vital signs at different time points. Drug side effects, including delirium and gastrointestinal symptoms, did not differ significantly between the methadone and ketamine groups.
Our clinical data support the hypothesis that ketamine is not inferior to methadone in patients with addiction. Future randomize clinical trials are needed to confirm these observations.
术后疼痛可导致多种并发症。不同阿片类药物在术后镇痛中的有效性已得到广泛研究。然而，管理阿片类药物成瘾患者的疼痛仍然具有挑战性。本研究旨在探讨氯胺酮和美沙酮对成瘾患者术后疼痛的影响。
这是一项非劣效性随机临床试验。所有纳入患者每3小时监测吗啡使用情况、疼痛评分和生命体征。干预组每6小时静脉注射0.5mg/kg氯胺酮。对照组每8小时肌肉注射5mg美沙酮。如果患者的视觉模拟评分高于3分，则给予静脉注射吗啡。记录每组的所有副作用。
本研究共纳入220例患者。其中男性127例（57.7%），平均年龄57.1±19.5岁；女性93例（42.3%），平均年龄57.1±21.0岁。两组间人口统计学特征无显著差异。两组间吗啡给药剂量和频率无显著差异。不同时间点两组间疼痛评分和生命体征无显著差异。美沙酮组和氯胺酮组的药物副作用，包括谵妄和胃肠道症状，无显著差异。
我们的临床数据支持氯胺酮在成瘾患者中不劣于美沙酮的假设。未来需要进行随机临床试验来证实这些观察结果。
