Chest
Original ResearchThoracic surgeryMorphine With Adjuvant Ketamine vs Higher Dose of Morphine Alone for Immediate Postthoracotomy Analgesia
Section snippets
Materials and Methods
This study is one part of a larger study conducted in the Post Anesthesia Care Unit on patients from the Department of Cardiovascular and Thoracic Surgery at the Tel-Aviv Sourasky Medical Center during the period 2001–2004 and had been approved by the Ethics Committee of the institution. The present cohort consisted of the first, more homogeneous group of patients, whereas data pertaining to the second and larger part of the cohort appear in a recent report elsewhere.22 Forty-four patients
Results
Of 62 screened patients, 44 patients fulfilled the study criteria for randomization. Three patients subsequently dropped out after surgery because they required continuous ventilation (CONSORT statement, Fig 1); no MIDCAB patient was converted to an on-pump procedure. Demographic, anesthesia, and surgical data were similar between the two drug study groups (Table 1); intraoperative blood replacement and fluid infusion were similar as well (data not shown). Baseline (immediately before starting
Discussion
Our study demonstrates that the administration of an IV subanesthetic dose (5 mg/bolus) of ketamine combined with two thirds of the standard (1.5-mg) morphine dose provided lower subjective measures of pain (by > 2 points on a scale of 1 to 10) than the standard morphine dose alone during the immediate (4 h) postthoracotomy period. The combined protocol was also associated with remarkably stable hemodynamic conditions and better respiratory parameters than the MO group. These objective effects
Acknowledgment
The authors thank Esther Eshkol, MA (institutional medical copyeditor, Tel Aviv Sourasky Medical Center) for editorial assistance, and the nursing staff of the PACU for their collaboration and dedication.
References (30)
- et al.
A comparative evaluation of intrapleural and thoracic epidural analgesia for postoperative pain relief after minimally invasive direct coronary artery bypass surgery
J Cardiothorac Vasc Anesth
(1998) - et al.
Acute pain management for patients undergoing thoracotomy
Ann Thorac Surg
(2003) - et al.
Perspective on pain management in the 21st century
J PeriAnesth Nurs
(2008) - et al.
The prevalence of chronic chest and leg pain following cardiac surgery: a historical cohort study
Pain
(2003)Pain
(2004) - et al.
Mechanisms of hyperalgesia and morphine tolerance: a current view of their possible interactions
Pain
(1995) - et al.
Experimental mononeuropathy reduces the antinociceptive effects of morphine: implications for common intracellular mechanisms involved in morphine tolerance and neuropathic pain
Pain
(1995) - et al.
Adverse events of procedural sedation and analgesia in a pediatric emergency department
Ann Emerg Med
(1999) - et al.
Improved pain control after cardiac surgery: results of a randomized, double-blind, clinical trial
J Thorac Cardiovasc Surg
(2003) - et al.
Patients' perceptions of pain management after cardiac surgery in an Australian critical care unit
Heart Lung
(2004) - et al.
Ketamine spares morphine consumption after transthoracic lung and heart surgery without adverse hemodynamic effects
Pharmacol Res
(2008)
Postoperative analgesia and sedation following pediatric cardiac surgery using a constant infusion of ketamine
J Cardiothorac Vasc Anesth
Ketamine sedation for pediatric procedures: part 1
A prospective series, Ann Emerg Med
Analgesic pharmacology: II. Specific analgesics
J Am Acad Orthop Surg
A comparison of intrathecal opioid and intravenous analgesia for the incidence of cardiovascular, respiratory, and renal complications after abdominal aortic surgery
Anesth Analg
The effects of postoperative pain management on immune response to surgery
Anesth Analg
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Parts of this study were presented at the Euroanaesthesia 2003 Meeting, Glasgow, Scotland May 31-June 3, 2003; and at the fifth International Congress on Coronary Artery Disease, Florence, Italy, October 19–22, 2003.
No financial support was received for this clinical trial.
The authors have no conflicts of interest to disclose.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).