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Low-dose ketamine failed to spare morphine after a remifentanil-based anaesthesia for ear, nose and throat surgery

Published online by Cambridge University Press:  02 June 2005

O. Ganne ,
M. Abisseror ,
P. Menault ,
S. Malhière ,
V. Chambost ,
B. Charpiat ,
C. Ganne  and
J. P. Viale
O. Ganne
Affiliation:
Hôpital de Villefranche-sur-Saône, Department of Anaesthesiology, Villefranche-sur-Saône, Lyon, France
M. Abisseror
Affiliation:
Hôpital de la Croix-Rousse, Department of Anaesthesiology and Intensive Care, Lyon, France
P. Menault
Affiliation:
Hôpital de la Croix-Rousse, Department of Anaesthesiology and Intensive Care, Lyon, France
S. Malhière
Affiliation:
Hôpital de la Croix-Rousse, Department of Anaesthesiology and Intensive Care, Lyon, France
V. Chambost
Affiliation:
Hôpital de la Croix-Rousse, Department of Pharmacy, Lyon, France
B. Charpiat
Affiliation:
Hôpital de la Croix-Rousse, Department of Pharmacy, Lyon, France
C. Ganne
Affiliation:
Hôpital de Villefranche-sur-Saône, Department of Anaesthesiology, Villefranche-sur-Saône, Lyon, France
J. P. Viale
Affiliation:
Hôpital de la Croix-Rousse, Department of Anaesthesiology and Intensive Care, Lyon, France
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Extract

Summary

Background: Ketamine has been claimed to prevent acute opioid tolerance and hyperalgesia following acute exposure to opioids and its use has been proposed to decrease postoperative morphine consumption.

Methods: We conducted a randomized, double-blind, controlled study to evaluate the effect of intravenous (i.v.) ketamine on postoperative pain for 48 h after major ear, nose and throat (ENT) surgery. Thirty-one patients received i.v. ketamine 0.15 mg kg−1 before induction and 2 μg kg−1 min−1 during anaesthesia, and 31 patients were administered placebo in a similar manner. Anaesthesia was standardized with remifentanil and propofol, but without nitrous oxide. Standardized postoperative analgesia included paracetamol, methylprednisolone and morphine administered via a patient controlled analgesia (PCA) device.

Results: Intra-operative remifentanil consumption was not different between the ketamine group (0.25 ± 0.07 μg kg−1 min−1) and the control group (0.22 ± 0.07 μg kg−1 min−1). In the postoperative period, both groups experienced an identical pain course evolution. Cumulative morphine consumption was not significantly different between groups: at 24 h it was 33.3 ± 14.9 with ketamine and 31.9 ± 15.3 mg in controls, at 48 h it was 40.4 ± 20.6 mg with ketamine and 42.5 ± 25.9 mg in controls.

Conclusion: Low-dose ketamine added to a remifentanil-based propofol anaesthesia did not reduce morphine consumption after major ENT surgery.

Keywords

KETAMINEPAIN POSTOPERATIVEANALGESICS OPIOID, morphine, remifentanilSURGERY, otorhinolaryngological
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 6 , June 2005 , pp. 426 - 430
Copyright
© 2005 European Society of Anaesthesiology

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References

Celerier E, Laulin J, Larcher A, Le Moal M, Simonnet G. Evidence for opiate-activated NMDA processes masking opiate analgesia in rats. Brain Res 1999; 847: 18–25.Google Scholar
Guignard B, Bossard AE, Coste C, et al. Acute opioid tolerance: intraoperative remifentanil increases postoperative pain and morphine requirement. Anesthesiology 2000; 93: 409–417.Google Scholar
Hayashida M, Fukunaga A, Hanaoka K. Detection of acute tolerance to the analgesic and nonanalgesic effects of remifentanil infusion in a rabbit model. Anesth Analg 2003; 97: 1347–1352.Google Scholar
Hood DD, Curry R, Eisenach JC. Intravenous remifentanil produces withdrawal hyperalgesia in volunteers with capsaicin-induced hyperalgesia. Anesth Analg 2003; 97: 810–815.Google Scholar
Kissin I, Bright CA, Bradley Jr EL. The effect of ketamine on opioid-induced acute tolerance: can it explain reduction of opioid consumption with ketamine-opioid analgesic combinations? Anesth Analg 2000; 91: 1483–1488.Google Scholar
De Kock M, Lavand'homme P, Waterloos H. ‘Balanced analgesia’ in the perioperative period: is there a place for ketamine? Pain 2001; 92: 373–380.Google Scholar
Guignard B, Coste C, Costes H, et al. Supplementing desflurane–remifentanil anesthesia with small-dose ketamine reduces perioperative opioid analgesic requirements. Anesth Analg 2002; 95: 103–108.Google Scholar
Ilkjaer S, Petersen KL, Brennum J, Wernberg M, Dahl JB. Effect of systemic N-methyl-d-aspartate receptor antagonist (ketamine) on primary and secondary hyperalgesia in humans. Br J Anaesth 1996; 76: 829–834.Google Scholar
Jaksch W, Lang S, Reichhalter R, Raab G, Dann K, Fitzal S. Perioperative small-dose S(+)-ketamine has no incremental beneficial effects on postoperative pain when standard-practice opioid infusions are used. Anesth Analg 2002; 94: 981–986.Google Scholar
Dahl V, Ernoe PE, Steen T, Raeder JC, White PF. Does ketamine have preemptive effects in women undergoing abdominal hysterectomy procedures? Anesth Analg 2000; 90: 1419–1422.Google Scholar
Subramaniam K, Subramaniam B, Steinbrook RA. Ketamine as adjuvant analgesic to opioids: a quantitative and qualitative systematic review. Anesth Analg 2004; 99: 482–495.Google Scholar
Elia N, Tramèr MR. Ketamine and postoperative pain – a quantitative systematic review of randomised trials. Pain 2005; 113: 61–70.Google Scholar
Gilabert Morell A, Sanchez Perez C. [Effect of low-dose intravenous ketamine in postoperative analgesia for hysterectomy and adnexectomy.] Rev Esp Anestesiol Reanim 2002; 49: 247–253.Google Scholar
Kwok RF, Lim J, Chan MT, Gin T, Chiu WK. Preoperative ketamine improves postoperative analgesia after gynecologic laparoscopic surgery. Anesth Analg 2004; 98: 1044–1049.Google Scholar
Roytblat L, Korotkoruchko A, Katz J, Glazer M, Greemberg L, Fisher A. Postoperative pain: the effect of low-dose ketamine in addition to general anesthesia. Anesth Analg 1993; 77: 1161–1165.Google Scholar
Ngan Kee WD, Khaw KS, Ma ML, Mainland PA, Gin T. Postoperative analgesic requirement after Caesarean section: a comparison of anesthetic induction with ketamine or thiopental. Anesth Analg 1997; 85: 1294–1298.Google Scholar
Takahashi T, Kimoto T, Tanabe N, Hattori TA, Yasumatsu N, Kawato S. Corticosterone acutely prolonged N-methyl-d-aspartate receptor-mediated Ca2+ elevation in cultured rat hippocampal neurons. J Neurochem 2002; 83: 1441–1451.Google Scholar
Cho K, Little HJ. Effects of corticosterone on excitatory amino acid responses in dopamine-sensitive neurons in the ventral segmental area. Neuroscience 1999; 88: 837–845.Google Scholar
Angst MS, Koppert W, Pahl I, Clark DJ, Schmelz M. Short-term infusion of the mu-opioid agonist remifentanil in humans causes hyperalgesia during withdrawal. Pain 2003; 106: 49–57.Google Scholar
Koppert W, Sittl R, Scheuber K, Alsheimer M, Schmelz M, Schuttler J. Differential modulation of remifentanil-induced analgesia and postinfusion hyperalgesia by S-ketamine and clonidine in humans. Anesthesiology 2003; 99: 152–159.Google Scholar
Morgan CJ, Mofeez A, Brandner B, Bromley L, Curran HV. Acute effects of ketamine on memory systems and psychotic symptoms in healthy volunteers. Neuropsychopharmacology 2004; 29: 208–218.Google Scholar
Hartvig P, Valtysson J, Lindner KJ, et al. Central nervous system effects of subdissociative doses of (S)-ketamine are related to plasma and brain concentrations measured with positron emission tomography in healthy volunteers. Clin Pharmacol Ther 1995; 58: 165–173.Google Scholar
Menigaux C, Guignard B, Fletcher D, Sessler DI, Dupont X, Chauvin M. Intraoperative small-dose ketamine enhances analgesia after outpatient knee arthroscopy. Anesth Analg 2001; 93: 606–612.Google Scholar
Zahn PK, Umali E, Brennan TJ. Intrathecal non-NMDA excitatory amino acid receptor antagonists inhibit pain behaviors in a rat model of postoperative pain. Pain 1998; 74: 213–223.Google Scholar