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Perioperative ketamine for acute postoperative pain

  • Review
  • Intervention

Authors


Abstract

Background

Postoperative pain management is often limited by adverse effects such as nausea and vomiting. Adjuvant treatment with an inexpensive opioid-sparing drug such as ketamine may be of value in giving better analgesia with fewer adverse effects.

Objectives

To evaluate the effectiveness and tolerability of ketamine administered perioperatively in the treatment of acute postoperative pain in adults.

Search methods

Studies were identified from MEDLINE (1966 to 2004), EMBASE (1980 to 2004), the Cochrane Database of Systematic Reviews (2004) and by handsearching reference lists from review articles and trials. The manufacturer of ketamine (Pfizer) provided search results from their in-house database, PARDLARS.

Selection criteria

Randomised controlled trials (RCTs) of adult patients undergoing surgery, being treated with perioperative ketamine or placebo. Studies where ketamine was administered in addition to a basic analgesic (such as morphine or NSAID) in one study group, and compared with a group receiving the same basic analgesic (but without ketamine) in another group, were also included.

Data collection and analysis

Two independent review authors identified fifty five RCTs for potential inclusion. Quality and validity assessment was performed by two independent review authors. In the case of discrepancy, a third review author was consulted. Patient reported pain intensity and pain relief was assessed using visual analogue scales or verbal rating scales and adverse effects data were collated.

Main results

Thirty-seven trials were included (2240 participants). Eighteen trials were excluded. Twenty-seven of the 37 trials found that perioperative subanaesthetic doses of ketamine reduced rescue analgesic requirements or pain intensity, or both. Quantitative analysis showed that treatment with ketamine reduced 24 hour PCA morphine consumption and postoperative nausea or vomiting (PONV). Adverse effects were mild or absent.

Authors' conclusions

Ketamine in subanaesthetic dose (that is a dose which is below that required to produce anaesthesia) is effective in reducing morphine requirements in the first 24 hours after surgery. Ketamine also reduces postoperative nausea and vomiting. Adverse effects are mild or absent.

摘要

背景

手術中給予ketamine 減輕手術後急性疼痛

手術後疼痛常因為一些副作用譬如說噁心和嘔吐而被侷限。輔藥治療給予一種便宜非opioid 類的藥物譬如說ketamine 也許有更好的止痛效果並且有較少的副作用。

目標

評估在手術中給予ketamine 在治療成人手術後的急性疼痛的有效性和可接受程度。

搜尋策略

研究從MEDLINE (1966 to 2004), EMBASE (1980 to 2004), the Cochrane Database of Systematic Reviews (2004)中去搜索及由handsearching 參考文獻去找尋回顧文章和試驗。ketamine 製造商(輝瑞藥廠)提供了查尋結果從他們機構內部的資料庫, PARDLARS 。

選擇標準

在成人手術中作隨機控制試驗(RCTs),在手術中給予ketamine或是安慰劑。所有的研究組都是給予ketamine和基本的止痛藥(譬如說嗎啡或NSAID類藥物),和另外一組比較接受同樣基本的止痛藥(但沒有ketamine)兩組之間的差別。

資料收集與分析

二位不同回顧作者辨認了五十五組RCTs研究可能符合適應症。由二位不同回顧作者執行了品質和有效性評估。在認為有差誤情況下, 將咨詢第三位作者。病患利用痛覺疼痛強度表或口頭量表來表示他們痛苦程度並且疼痛減輕程度和副作用。

主要結論

總共包含三十七種試驗(2240 個受試者)。十八個試驗被排除.三十七種試驗中的其中二十七種試驗發現手術中給予比麻醉藥量少的ketamine單一或同時減少了止痛藥的需求或痛苦強度。定量分析顯示給予ketamine 減少了24 小時PCA(病患自控式止痛) 嗎啡的消耗量和手術後噁心或嘔吐(PONV)。副作用是輕微的甚是沒有。

作者結論

Ketamine 在次麻醉劑量上(也就是比一般麻醉所需的劑量較小) 有效的在減少手術後24小時之嗎啡的需求用量。而且Ketamine同時減少手術後噁心和嘔吐的發生率。副作用是輕微的甚是沒有。

翻譯人

本摘要由三軍總醫院詹舜名翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

手術中給予次麻醉劑量Ketamine能有效的術後24小時內在嗎啡的使用量。而且Ketamine 同時減少手術後噁心和嘔吐的發生率。手術中給予Ketamine副作用是輕微的甚是沒有。但以現今的資料無法轉換成一個標準的治療配方。

Plain language summary

Perioperative ketamine for acute postoperative pain

Perioperative ketamine in subanaesthetic dose reduces postoperative morphine requirements and reduces postoperative nausea or vomiting (PONV). Adverse effects for perioperative ketamine are mild or absent. The current data cannot be translated into a specific treatment regime.

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