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ANESTHETIC PHARMACOLOGY

Postoperative Pain Relief After Hepatic Resection in Cirrhotic Patients: The Efficacy of a Single Small Dose of Ketamine Plus Morphine Epidurally

Pilar Taurá, MD^*, Josep Fuster, MD, PhD, Anabel Blasi, MD^*, Julia Martinez-Ocon, MD^*, Teresa Anglada, MD, PhD^*, Joan Beltran, MD^*, Jaume Balust, MD^*, Javier Tercero, MD^*, and Juan-Carlos Garcia-Valdecasas, MD, PhD

Departments of *Anesthesiology and Surgery, Universitat de Barcelona, Hospital Clínic, Barcelona, Spain

Address correspondence and reprint requests to Pilar Taurá, MD, Department of Anesthesiology, Universitat de Barcelona, Hospital Clínic, Villarroel 170, E-08036 Barcelona, Spain. Address e-mail to ptaura{at}clinic.ub.es

In cirrhotic patients undergoing hepatic surgery, postoperative analgesia remains a challenge. In this study, we evaluated the efficacy of a single dose of morphine combined with small-dose ketamine given epidurally for postoperative pain relief. One-hundred-four classification "Child A" cirrhotic patients were randomly assigned to two groups: 1) (MKG, n = 54): epidural morphine (3.5–5 mg) plus ketamine (20/30 mg); and 2) epidural morphine (3.5/5 mg) (MG, n = 50). The level of analgesia, side effects, psychomimetic and neurological disorders, additional analgesic needs, and overall quality of the analgesia were recorded. The mean duration of analgesia was longer in the MKG group (27.2 ± 8 h versus 16.4 ± 10 h; P < 0.05). In the MKG group, the visual analog scale (VAS) score began to be significantly lower from 14 h at rest and 12 h on coughing until the end of the study. The need for additional analgesia was also smaller in the MKG group (P < 0.05): at 24 h, only 10% of patients in the MKG group needed complementary analgesia, whereas in the MG group it was 100% (P = 0.003). Side effects were similar in both groups. Psychomimetic side effects and neurological disorders were not detected. These results suggest that postoperative analgesia provided by a single dose of epidural morphine with small-dose ketamine is effective in cirrhotic Child’s A patients having major upper abdominal surgery.

IMPLICATIONS: This is a clinical prospective and randomized trial. The study shows the efficacy and safety of a single-dose administration of epidural morphine plus small-dose ketamine given as the only treatment for postoperative pain relief in cirrhotic patients having liver resection.

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