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ANESTHETIC PHARMACOLOGY

Adding Ketamine to Morphine for Patient-Controlled Analgesia After Major Abdominal Surgery: A Double-Blinded, Randomized Controlled Trial

Department of Anaesthesia & Pain Management, Alfred Hospital; Departments of Anaesthesia, and Epidemiology & Preventive Medicine, Monash University, Australia

Address correspondence and reprint requests to David Lindholm, MB BS, Department of Anaesthesia & Pain Management, The Alfred Commercial Road, Prahran, Victoria, 3181 Australia. Address e-mail to D.Lindholm{at}alfred.org.au

In this double-blinded, randomized controlled trial we tested if the addition of ketamine to morphine for patient-controlled analgesia (PCA) resulted in improved analgesic efficacy and lower pain scores compared with morphine PCA alone after major abdominal surgery. Seventy-one patients were ran-domly allocated to receive either morphine 1 mg/mL (Group M) or morphine 1 mg/mL plus ketamine 1 mg/mL (Group MK) delivered via PCA after surgery. No other analgesics or regional blocks were permitted during the 48-h study period. Postoperatively there were no differences between the groups for subjective assessment of analgesic efficacy, pain scores at rest, and on movement, opioid consumption, or adverse events. Group MK patients performed worse in cognitive testing (P = 0.037). There was an increased risk of vivid dreaming in patients who received ketamine (relative risk = 1.8, 95% confidence interval 0.78–4.3). We conclude that small-dose ketamine combined with PCA morphine provides no benefit to patients undergoing major abdominal surgery.

Implications: We performed a randomized, controlled trial comparing the use of ketamine andmorphine with morphine alone to relieve pain after major abdominal surgery.Ketamine did not improve pain relief and merely increased sideeffects.

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