2005, Number 1
<< Back Next >>
Rev Mex Anest 2005; 28 (1)
Postoperative epidural analgesia: Ketamine plus bupivacaine vs. bupivacaine alone in hip and femur surgery
Rivera-Ordóñez A, Rivera-Flores J
Language: Spanish
References: 17
Page: 14-19
PDF size: 62.25 Kb.
ABSTRACT
The purpose of this study was to determine if epidural ketamine combined with a local anesthetic provides better postoperative anesthesia in hip and femur surgery. Fifty patients admitted to Balbuena General Hospital, ages 18 to 60 and ASA I-II, were enrolled the study. Once in the operating room, they were randomized to two groups, 25 patients each. Type I monitoring (cardioscope, sphygmomanometer and pulse oximeter) was used. An epidural catheter was inserted in both groups of patients for intraoperative anesthetic management, later used for postoperative analgesia. Upon termination of surgery, patients in Group 1 were given bupivacaine 20 mg in 10 ml saline solution; patients in Group 2 received ketamine, 200 μg/kg + bupivacaine 20 mg in 10 ml saline solution. Blood pressure, heart rate, respiratory rate, degree of motor blockade, VAS and side effects were monitored at 15 and 30 minutes and at 1, 2, 4, 8, 16 and 24 hours postoperatively. Results showed no statistically significant differences in vital signs. In Group 1, the VAS score at 4 hours was 5.45 ± 1.85; in Group 2 it was 2.19 ± 1.69. Ketamine combined with a local anesthetic provided better quality and longer lasting postoperative analgesia, with no adverse effects.
REFERENCES
Bromage RP. Analgesia epidural. Mallorca: Salvat, 1984:3-10.
Rivera SA. Analgesia postoperatoria II Técnicas Analgésicas. Revista Mexicana de Anestesia. 1992;15:85-95.
Miller RD. Anesthesia. Churchill Livingstone. 1990:1369-77.
Kathirvel SS, Sadhasivam. Effects of intrathecal Ketamine added to Bupivacaine for spinal anaesthesia. Anaesthesia 2000; 55: 899-903.
Koinig H, Marhofwer P. Analgesic effects of caudal and intramuscular 5 (+) Ketamine in children. Anesthesiology 2000;93: 976-80.
Chia YY, Liu K. Adding Ketamine in a multinodal patient controlled epidural regimen reduces postoperative pain and analgesic consumption. Anaesthesia and analgesic consumption. Anaesthesia and analgesia 1998;86:1245-9.
Álvarez RJJ. Ketamina: controversias y estado actual. Anestesia en México 1998;10:74-82.
Reich LD, Silva’s G. Ketamine: an update on the first twenty-five years of clinical experience. Canadian Journal Anaesthesia 1989;36:186-97.
Cartwright PD. Midazolam and Diazepam in Ketamine anesthesia. Anesthesia 1987;59:439-42.
Hitora K, Lambert DG. Ketamine: its mechanism (s) of action and unusual clinical uses. British Journal of Anaesthesia 1996;77:441-444.
Finch DA, Nagai SH. Opiate receptor mediation of Ketamine analgesia. Anesthesiology 1982;56:291-97.
Sato T, Hirota K. NMDA receptors are not involved in the relaxant effect of Ketamine on airways smooth muscle. Anesthesiology 1995;V83(3A):A359.
Marhofer P, Krenn CG. S (+)-Ketamine for caudal block in pediatrics anaesthesia. British Journal of Anaesthesia 2000;84: 341-345.
Yue YC, Shung WC. Intratecal Ketamine reduces morphine requirements in patients with terminal cancer pain. Canadian Journal Anaesthesia 1996;49:379-83.
Lee HM, Sanders GM. Caudal ropivacaine and Ketamine for postoperative analgesia in children. Anaesthesia 2000;55:798-810.
Weir PS, Fee JPH. Double-blind comparison of extradural block with three Bupivacaine-Ketamine mixtures in Knee arthroplasty. British Journal of Anaesthesia 1998;80:299-301.
Finck AD, Ngai SH. A possible mechanism of Ketamine induced analgesia. Anesthesiology 1982;56:291-7.