British Journal of Anaesthesia, Vol 81, Issue 5 707-712, Copyright © 1998 by The Board of Management and Trustees of the British Journal of Anaesthesia
S. Ilkjaer, L. Nikolajsen, T. M. Hansen, M. Wernberg, J. Brennum and J. B. Dahl
We studied 60 patients undergoing operation on the kidney with combined
general and epidural anaesthesia, in a double-blind, randomized, controlled
study. Patients were allocated to receive a preoperative bolus dose of
ketamine 10 mg i.v., followed by an i.v. infusion of ketamine 10 mg h-1 for
48 h after operation, or placebo. During the first 24 h after surgery, all
patients received 4 ml h-1 of epidural bupivacaine 2.5 mg ml-1. From 24 to
48 h after operation, patients received epidural morphine 0.2 mg h-1
preceded by a bolus dose of 2 mg. In addition, patient-controlled analgesia
(PCA) with i.v. morphine (2.5 mg, lockout time 15 min) was offered from 0
to 48 h after operation. Patients who received ketamine felt significantly
more sedated at 0-24 h, but not at 24-48 h after operation, compared with
patients who received placebo (P = 0.002 and P = 0.127, respectively).
There were no significant differences in pain (VAS) at rest, during
mobilization or cough, PCA morphine consumption, sensory block to pinprick,
pressure pain detection threshold assessed with an algometer, touch and
pain detection thresholds assessed with von Frey hairs, peak flow or side
effects other than sedation. The power of detecting a reduction in VAS
scores of 20 mm in our study was 80% at the 5% significance level. We
conclude that we were unable to demonstrate an (additive) analgesic or
opioid sparing effect of ketamine 10 mg h-1 i.v. combined with epidural
bupivacaine at 0-24 h, or epidural morphine at 24-48 h after renal surgery.
CLINICAL INVESTIGATIONS
Effect of i.v. ketamine in combination with epidural bupivacaine or epidural morphine on postoperative pain and wound tenderness after renal surgery
Department of Anaesthesiology, Skejby Hospital, Aarhus University Hospital, DK-8200 Aarhus, Denmark; Department of Neurosurgery, Rigshospitalet, DK-2100 Copenhagen, Denmark; Department of Anaesthesiology, Herlev University Hospital, DK-2730 Herlev, Denmark
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