Hallikeri Shivani Vijayakumar, Sinha Renu, Ray Bikas Ranjan, Pandey Ravindra Kumar, Darlong Vanlal, Punj Jyotsna, Bansal Virinder Kumar, Saxena Renu
All India Institute of Medical Sciences, Department of Anaesthesiology, Pain Medicine and Critical Care, New Delhi, India.
Turk J Anaesthesiol Reanim. 2024 Dec 16;52(6):231-239. doi: 10.4274/TJAR.2024.241771.
The neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) are indicators of postoperative inflammatory response. Low-dose ketamine has analgesic and anti-inflammatory properties. Inguinal hernia surgery is associated with a higher incidence of chronic pain.
Sixty patients aged 18-60 years; American Society of Anesthesiologists status I and II who were scheduled for laparoscopic inguinal hernia surgery were included. After the induction of general anaesthesia, a ketamine 0.5 mg kg bolus, followed by a 0.2 mg kg h infusion (group K) or saline bolus and infusion (group S) was administered until the end of the surgery. Blood samples were collected at various time intervals. Fentanyl requirement, hemodynamics, verbal analog scale (VAS), emergence delirium, recovery, postoperative nausea and vomiting, and chronic pain were recorded.
Median (interquartile range) NLR was 4.63 times increased at 2 hours postoperatively from the baseline in group S [2.07 (1.72-2.79) to 7.91 (5.74-14.7)] as compared to 2.53 times increase in group K [1.85 (1.4-2.61) to 5.45 (2.89-7.61)] (=0.02). The increase in median PLR from baseline to 2 hours postoperatively was greater in group S (2.98 times) than in group K (1.94 times) (=0.02). The NLR and PLR were comparable on POD1 between the groups. Fentanyl requirement was significantly higher in group S compared to Group K both intraoperatively, (=0.01) and two hours postoperatively (=0.047). More patients had chronic pain and VAS scores in group S than in group K (13 vs 5, =0.05).
Low-dose ketamine reduces postoperative inflammatory response, decreases perioperative opioid requirement, and reduces incidence of chronic pain after laparoscopic inguinal hernia surgery with no significant side effects.
中性粒细胞淋巴细胞比值（NLR）和血小板淋巴细胞比值（PLR）是术后炎症反应的指标。低剂量氯胺酮具有镇痛和抗炎特性。腹股沟疝手术与慢性疼痛的较高发生率相关。
纳入60例年龄在18至60岁之间、美国麻醉医师协会分级为I级和II级、计划行腹腔镜腹股沟疝手术的患者。全身麻醉诱导后，给予氯胺酮0.5mg/kg静脉推注，随后以0.2mg·kg⁻¹·h⁻¹持续输注（K组）或生理盐水推注及输注（S组），直至手术结束。在不同时间间隔采集血样。记录芬太尼需求量、血流动力学、视觉模拟评分（VAS）、苏醒期谵妄、恢复情况、术后恶心呕吐及慢性疼痛情况。
与K组术后2小时NLR较基线升高2.53倍[1.85（1.4 - 2.61）至5.45（2.89 - 7.61）]相比，S组术后2小时NLR较基线升高4.63倍[2.07（1.72 - 2.79）至7.91（5.74 - 14.7）]（P = 0.02）。S组术后2小时PLR较基线的升高幅度（2.98倍）大于K组（1.94倍）（P = 0.02）。两组术后第1天的NLR和PLR相当。S组术中（P = 0.01）及术后2小时（P = 0.047）的芬太尼需求量均显著高于K组。S组慢性疼痛患者及VAS评分高于K组（13例对5例，P = 0.05）。
低剂量氯胺酮可减轻腹腔镜腹股沟疝手术后的炎症反应，降低围手术期阿片类药物需求量，并降低慢性疼痛发生率，且无明显副作用。
