Gurnani A, Sharma P K, Rautela R S, Bhattacharya A
Department of Anaesthesiology and Critical Care, University College of Medical Sciences, Shahdara, Delhi, India.
Anaesth Intensive Care. 1996 Feb;24(1):32-6. doi: 10.1177/0310057X9602400106.
Low-dose ketamine by subcutaneous infusion (0.1 mg/kg/h) was compared in double-blind fashion with intermittent morphine (0.1 mg/kg intravenously, four-hourly) as analgesic regimen in 40 ASA-I adults after acute musculoskeletal trauma. Pain was assessed using visual analogue scales and sedation was graded on a four point rank drowsiness score. Objective cardiovascular and respiratory parameters and patient acceptability in terms of supplementary analgesia and early mobilization were also recorded. Pain relief was better with the ketamine infusion than with intermittent morphine (P < 0.001). Patients were more awake and alert with ketamine infusion as evidenced by the drowsiness score (P < 0.001). Peak expiratory flow rate improved significantly with the ketamine infusion (P < 0.05). None of the patients in ketamine group required supplementary analgesia (P < 0.001) and the patients could be easily mobilized for traction/splintage as compared with patients in the control group (P < 0.001). The incidence of nausea and vomiting in the morphine group was high (P < 0.01). The study shows that subcutaneous infusion of ketamine provides safe and effective analgesia in acute musculoskeletal trauma.
在40例急性肌肉骨骼创伤后的ASA-I级成年患者中，以双盲方式比较了皮下输注低剂量氯胺酮（0.1毫克/千克/小时）与间歇性吗啡（0.1毫克/千克静脉注射，每4小时一次）作为镇痛方案的效果。使用视觉模拟量表评估疼痛，并根据四点嗜睡评分对镇静程度进行分级。还记录了客观的心血管和呼吸参数以及患者在补充镇痛和早期活动方面的可接受性。氯胺酮输注组的疼痛缓解效果优于间歇性吗啡组（P < 0.001）。嗜睡评分显示，氯胺酮输注组患者更清醒警觉（P < 0.001）。氯胺酮输注后呼气峰值流速显著改善（P < 0.05）。氯胺酮组无一例患者需要补充镇痛（P < 0.001），与对照组患者相比，氯胺酮组患者可轻松进行牵引/夹板固定（P < 0.001）。吗啡组恶心和呕吐的发生率较高（P < 0.01）。该研究表明，皮下输注氯胺酮可为急性肌肉骨骼创伤提供安全有效的镇痛。
