80 research outputs found
Effects of Ketamine on Postoperative Pain After Remifentanil-Based Anesthesia for Major and Minor Surgery in Adults: A Systematic Review and Meta-Analysis
Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, has been postulated
as an adjuvant analgesic for preventing remifentanil-induced hyperalgesia after surgery.
This systematic review and meta-analysis aims to assess the effectiveness of ketamine
[racemic mixture and S-(+)-ketamine] in reducing morphine consumption and pain
intensity scores after remifentanil-based general anesthesia. We performed a literature
search of the PubMed, Web of Science, Scopus, Cochrane, and EMBASE databases
in June 2017 and selected randomized controlled trials using predefined inclusion and
exclusion criteria. To minimize confounding and heterogeneity, studies of NMDA receptor
antagonists other than ketamine were excluded and the selected studies were grouped
into those assessing minor or major surgery. Methodological quality was evaluated
with the PEDro and JADA scales. The data were extracted and meta-analyses were
performed where possible. Twelve RCTs involving 156 adults who underwent minor
surgery and 413 adults who underwentmajor surgery were included in themeta-analysis.
When used as an adjuvant to morphine, ketamine reduced postoperative morphine
consumption in the first 24 h and postoperative pain intensity in the first 2 h in the minor
and major surgery groups. It was also associated with significantly reduced pain intensity
in the first 24 h in the minor surgery group. Time to the first rescue analgesia was longer in
patients who received ketamine and underwent major surgery. No significant differences
in the incidence of ketamine-related adverse effects were observed among patients in
the intervention group and controls. This systematic review and meta-analysis show that
low-dose (<0.5 mg/kg for iv bolus or <5 ÎĽg/kg/min for iv perfusion) of ketamine reduces
postoperative morphine consumption and pain intensity without increasing the incidence
of adverse effects
The Effects of Intraoperative Adenosine Infusion on Acute Opioid Tolerance and Opioid Induced Hyperalgesia Induced by Remifentanil in Adult Patients Undergoing Tonsillectomy
The effects of low doses of pregabalin on morphine analgesia in advanced cancer patients
Abstract
OBJECTIVES:
The aim of this study was to evaluate the opioid response in patients receiving morphine and pregabalin, independently from the presumed pain mechanisms, in comparison with patients receiving morphine treatment only.
METHODS:
A multicenter prospective randomized controlled study was carried out in a sample of 70 advanced cancer patients with pain requiring strong opioids. Thirty-five patients (group MO) were randomized to receive sustained-release morphine using initial doses of 60 mg/day. Thirty-five patients (group MO-PR) were randomized to start the same morphine doses and pregabalin in increasing doses, starting with 25 mg/day up to 150 mg/day in one week. The following data were also recorded before starting the treatments (T0) and then at week intervals for four weeks (W1-4): age, gender, primary cancer and known metastases, pain causes and mechanisms, symptoms associated with opioid therapy, pain intensity, Brief Pain Inventory (BPI), morphine doses and escalation indexes (OEIs), and quality of life.
RESULTS:
Forty-eight patients completed the study, twenty-eight and sixteen patients in group MO and MO-PR, respectively. Twenty patients were females, the mean age was 65.5 (± 10.3), and the mean Karnofsky status was 66.0 (± 18.9). No differences between groups were found in age (P = 0.839), Karnofsky status (P = 0.741), opioid doses as well as escalation indexes (OEI mg, P = 0.260, and OEI%, P = 0.270). No differences between the two groups were found in quality of life and all BPI items.
CONCLUSION:
The use of low doses of pregabalin added to morphine therapy in advanced cancer patients does not seem to provide advantageous analgesic effects, despite limitations of the present study due to the number of drop-outs
Intraoperative ketamine does not improve postoperative analgesia after scoliosis surgery in adolescent
Ketamine in outpatient arthroscopic shoulder surgery: Effects on postoperative pain, hemodynamic stability and process times
Ketamine added to intravenous patient-controlled morphine: Ketamine plasma concentration is unreliable [1] (multiple letters)
PubMedID: 15055900[No abstract available
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