Ghezel-Ahmadi Verena, Beck Grietje, Bölükbas Servet, Ghezel-Ahmadi David
Department of Anaesthesiology, Critical Care and Pain Medicine, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany.
Department of Thoracic Surgery and Thoracic Endoscopy, University Medical Center Essen-Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany.
J Thorac Dis. 2024 Dec 31;16(12):8461-8471. doi: 10.21037/jtd-24-648. Epub 2024 Dec 28.
Moderate to severe postoperative pain is common among patients following thoracotomy and serves as a risk factor for developing chronic post-thoracotomy pain (CPTP). This randomized controlled trial evaluated the effects of pre-emptively administered ketamine compared to placebo and standard care on both acute postoperative pain and CPTP.
Two hundred patients were enrolled in this prospective, randomized trial. The presence and severity of pain were assessed before surgery, first 6 hours after surgery, on postoperative days (PODs) 1-8, 30, and 90. For documentation of neuropathic pain, the Leeds Assessment Score for Neuropathic Symptoms and Signs (LANSS) was used pre- and postoperatively. The incidence and severity of CPTP was assessed by a telephone survey, the self-assessment LANSS (S-LANSS) 30 and 90 days after surgery.
There was significant difference in numeric rating scale (NRS) pain scores when coughing in the first 6 hours after surgery, with less pain in the ketamine group. No difference was seen in NRS pain scores at rest and coughing between the ketamine and placebo group on PODs 1-8. There was no difference in the opioid consumption between the two groups. Thirty-four (18.7%) of the patients had a S-LANSS score ≥12 30 days following surgery, 12 (12.8%) in the ketamine group 22 (25%) in the placebo group (P=0.001). Thirty-three (18.2%) of all patients had a S-LANSS score ≥12 90 days following surgery 8 (8.5%) in the ketamine group 25 (28.4%) in the placebo group (P<0.001).
In summary, pre-emptive ketamine does not reduce opioid consumption and NRS scores after thoracotomy but more importantly it lowers significantly the incidence of chronic postoperative pain, especially neuropathic pain.
The study was registered at ClinicalTrials.gov (NCT03105765).
开胸术后患者中，中度至重度术后疼痛很常见，并且是发生慢性开胸术后疼痛（CPTP）的一个危险因素。这项随机对照试验评估了与安慰剂和标准护理相比，预先给予氯胺酮对术后急性疼痛和CPTP的影响。
200名患者参与了这项前瞻性随机试验。在手术前、术后首6小时、术后第1 - 8天、30天和90天评估疼痛的存在和严重程度。为记录神经性疼痛，术前和术后使用利兹神经病理性症状和体征评估量表（LANSS）。通过电话调查、术后30天和90天的自我评估LANSS（S - LANSS）评估CPTP的发生率和严重程度。
术后首6小时咳嗽时，数字评分量表（NRS）疼痛评分有显著差异，氯胺酮组疼痛较轻。术后第1 - 8天，氯胺酮组和安慰剂组静息和咳嗽时的NRS疼痛评分无差异。两组之间的阿片类药物消耗量无差异。术后30天，34名（18.7%）患者的S - LANSS评分≥12，氯胺酮组12名（12.8%），安慰剂组22名（25%）（P = 0.001）。术后90天，所有患者中有33名（18.2%）的S - LANSS评分≥12，氯胺酮组8名（8.5%），安慰剂组25名（28.4%）（P<0.001）。
总之，预先给予氯胺酮并不能减少开胸术后的阿片类药物消耗量和NRS评分，但更重要的是，它能显著降低慢性术后疼痛的发生率，尤其是神经性疼痛。
该研究在ClinicalTrials.gov（NCT03105765）注册。
