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CRITICAL CARE AND TRAUMA

The Effects of Small-Dose Ketamine on Morphine Consumption in Surgical Intensive Care Unit Patients After Major Abdominal Surgery

Nicolas Guillou, MD^*, Michèle Tanguy, MD^*, Philippe Seguin, MD^*, Bernard Branger, MD, Jean-Pierre Campion, MD, and Yannick Mallédant, MD^*

*Surgical Intensive Care Unit, Biostatistical Unit, and Surgical Unit, Hôpital Pontchaillou, Rennes, France

Address correspondence and reprint requests to Yannick Mallédant, MD, Service d’Anesthésie-Réanimation Chirurgicale 1, Hôpital Pontchaillou, 2 rue Henri le Guilloux, 35033 Rennes Cedex 9, France. Address e-mail to yannick.malledant{at}chu-rennes.fr

In a randomized, double-blinded study, we evaluated the analgesic effect of ketamine in the management of pain in a surgical intensive care unit after major abdominal surgery. Patients received morphine patient-controlled analgesia with either placebo (Group M) or ketamine (Group K). Morphine was administered with initial loading doses of 2 mg until the visual analog scale (VAS) score was <30 and thereafter with bolus doses of 1 mg and a lockout time of 7 min. Ketamine was administered with an initial bolus of 0.5 mg/kg followed by a perfusion of 2 µg · kg^-1 · min^-1 during the first 24 h and 1 µg · kg^-1 · min^-1 during the following 24 h. The 4-h cumulative morphine doses were measured over 48 h. The VAS scores at rest and at mobilization were measured every 4 h during 48 h. A total of 101 patients were enrolled, and 93 were analyzed (41 in Group K and 52 in Group M). VAS scores at rest and at mobilization were similar. The cumulative consumption of morphine was significantly smaller in Group K (P < 0.05). We concluded that small doses of ketamine were a valuable adjunct to opioids in surgical intensive care unit patients after major abdominal surgery.

IMPLICATIONS: In a randomized, double-blinded study, we evaluated the effect of adding small-dose ketamine in combination with morphine patient-controlled analgesia in the management of pain after major abdominal surgery. For the same level of analgesia, the addition of ketamine reduced the consumption of morphine without side effects and may be a useful adjunct.

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