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A single small dose of postoperative ketamine provides rapid and sustained improvement in morphine analgesia in the presence of morphine-resistant pain



A single small dose of postoperative ketamine provides rapid and sustained improvement in morphine analgesia in the presence of morphine-resistant pain



Anesthesia and Analgesia 96(3): 789-95, Table of Contents



It is a common clinical observation that postoperative pain may be resistant to morphine. The analgesic potentials of ketamine have also been well documented. In this study, we evaluated the effects of postoperative co-administration of small doses of ketamine and morphine on pain intensity, Spo2, and subjectively rated variables in surgical patients who underwent standardized general anesthesia and complained of pain (gtoreq6 of 10 on a visual analog scale (VAS)) despite >0.1 mg/kg of IV morphine administration within 30 min. Patients randomly received up to three boluses of 30 mug/kg of morphine plus saline (MS; n = 114) or 15 mug/kg of morphine plus 250 mug/kg of ketamine (MK; n = 131) within 10 min in a double-blinded manner. The MS group's pain VAS scores were 5.5 +- 1.18 and 3.8 +- 0.9 after 10 and 120 min, respectively, after 2.52 +- 0.56 injections, versus the MK group's VAS scores of 2.94 +- 1.28 and 1.47 +- 0.65, respectively (P < 0.001), after 1.35 +- 0.56 injections (P < 0.001). The 10-min level of wakefulness (1-10 VAS) in the MS group was significantly (P < 0.001) less (6.1 +- 1.5) than the MK group's (8.37 +- 1.19). Spo2 decreased by 0.26% in the MS group but increased by 1.71% in the MK patients at the 10-min time point (P < 0.001). Thirty MS versus nine MK patients (P < 0.001) experienced nausea/vomiting; nine MK patients sustained a 2-min light-headed sensation, and one patient had a weird dream after the second drug injection.

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Accession: 010099291

Download citation: RISBibTeXText

PMID: 12598264

DOI: 10.1213/01.ane.0000048088.17761.b4


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