A randomized, controlled trial of a clinical pharmacist intervention in microdiscectomy surgery - Low dose intravenous ketamine as an adjunct to standard therapy

作者：Hadi Bushra A^*; Daas Rafat; Zelko Romana

来源：Saudi Pharmaceutical Journal, 2013, 21(2): 169-175.

DOI：10.1016/j.jsps.2012.08.002

• Ketamine
• Microdiscectomy surgery
• Intra-operative
• Post-operative
• Morphine consumption
• Nausea and vomiting

Aim: The hypothesis that postoperative pain would be reduced by using 1 mu g/kg/min of ketamine, both intra- and post-operatively, for lumbar microdiscectomy surgery was assessed by measuring morphine consumption. Patient side effects were reported.
Methods: Forty-five patients undergoing microdiscectomy surgery were randomized under double- blind conditions into three groups: Group1 (G1) received normal saline, Group 2 (G2) ketamine (1 mu g/kg/min) intra- operatively and Group 3 (G3) ketamine (1 mu g/kg/min) both intra- and postoperatively. Morphine consumption, pain scores, nausea and vomiting, CNS disorders were recorded for 24 h post surgery. This study was conducted by applying the concept of a clinical pharmacist intervention.
Results: The time for the first analgesia demand dose was significantly shorter (P < 0.05) in G117 +/- 1.7 min than for G2 and G3. In G3 morphine consumption 6, 12, and 24 h after surgery was 3 +/- 2.26, 9.2 +/- 2.11 and 26.9 +/- 2.71 mg. Total morphine consumption was significantly lower for G3 than for G1 or G2 (P < 0.05). The visual analog scale score (VAS) values were significantly lower in G3 (P < 0.05) than for the other groups during the first 24 h. The rate of nausea and vomiting was significantly higher in G1 vs G3 (P< 0.05). No difference in drug induced CNS disturbances was observed among the groups.
Conclusions: Using 1 lg/kg/min of ketamine hydrochloride intra- and post-operatively for microdiscectomy surgery could be an adjunct therapy to reduce postoperative morphine consumption minimizing its side effects.

• 出版日期2013-4