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PAIN MEDICINE

Improvement of Pain Treatment After Major Abdominal Surgery by Intravenous S(+)-Ketamine

Helena Argiriadou, MD^*, Sabine Himmelseher, MD, Pinelopi Papagiannopoulou, MD, Mary Georgiou, MD, Fotios Kanakoudis, MD, Maria Giala, MD^*, and Eberhard Kochs, MD PhD

*Department of Anesthesiology, AHEPA University Hospital, Thessaloniki, Greece; Klinik für Anaesthesiologie, Technische Universität München, Munich, Germany; and Department of Anesthesiology, G. Gennimatas University Hospital, Thessaloniki, Greece

Address correspondence and reprint requests to Helena Argiriadou, MD, Department of Anesthesiology, AHEPA University Hospital, St. Kyriakidi 1, 54636 Thessaloniki, Greece. Address e-mail to papaziog{at}med.auth.gr

The use of intraoperative racemic ketamine for pain prevention after abdominal surgery is controversial. We compared one preincisional IV injection of S(+)-ketamine with its preincisional and repeated intraoperative use in 45 patients undergoing surgery with epidural and general anesthesia. S(+)-ketamine is a new drug formulation that contains the more potent S(+)-stereoisomer of ketamine. Patients were randomized to receive placebo, 0.5 mg/kg preincisional S(+)ketamine, or 0.5 mg/kg preincisional and 0.2 mg/kg intraoperative S(+)-ketamine repeated at 20-min intervals. In the postoperative period, epidural ropivacaine (2 mg/mL; 0.12 mL · kg^–1 · h^–1) was infused for pain therapy. Patients who received repeated S(+)-ketamine reported smaller pain scores than those who received placebo after awakening and 3 and 6 h later (P 0.05). Fewer patients with repeated S(+)-ketamine required additional analgesics than those with placebo (P 0.05). Cumulative consumption of additional diclofenac and dextropropoxyphene at 24 h was less after single (P < 0.05) and repeated (P < 0.05) S(+)-ketamine versus placebo. After awakening, patients who received repeated S(+)-ketamine reported being in a better mood than those in the other groups (P < 0.05). No psychotomimetic side effects were noted. In conclusion, preincisional and repeated intraoperative small-dose S(+)-ketamine added to general and epidural anesthesia causes better postoperative pain relief than general and epidural anesthesia alone.

IMPLICATIONS: After major visceral surgery, preincisional and repeated intraoperative small-dose S(+)-ketamine added to general and epidural anesthesia causes better postoperative pain relief than general and epidural anesthesia alone.

This article has been cited by other articles:

				T. Sprenger, M. Valet, R. Woltmann, C. Zimmer, R. Freynhagen, E. F. Kochs, T. R. Tolle, and K. J. Wagner Imaging pain modulation by subanesthetic s-(+)-ketamine. Anesth. Analg., September 1, 2006; 103(3): 729 - 737. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999