title: Adding ketamine in a multimodal patient-controlled epidural regimen reduces postoperative pain and analgesic consumption.
abstract: We designed this double-blind study to evaluate the effect of adding small-dose ketamine in a multimodal regimen of postoperative patient-controlled epidural analgesia (PCEA). Ninety-one patients, ASA physical status I-III, undergoing major surgery, received a standardized general anesthesia and epidural catheterization in an appropriate intervertebral space after surgery. A PCEA device was programmed to deliver a regimen of morphine 0.02 mg/mL, bupivacaine 0.8 mg/mL, and epinephrine 4 microg/mL, with the addition of ketamine 0.4 mg/mL (ketamine, n = 45) or without (control, n = 46). The mean visual analog pain scale (VAS) scores during cough or movement for the first 3 days after surgery were higher in the control group than in the ketamine group (P < 0.05), whereas the mean VAS score at rest for the first 2 days were higher in the control group than in the ketamine group (P < 0.05). Furthermore, patients in the control group consumed more multimodal analgesics than patients in the ketamine group for the first 2 days (P < 0.05). The sedation scores and the incidence of side effects (pruritus, nausea, emesis, sleep deprivation, motor block, and respiration depression) were similar between the two groups. We conclude that adding ketamine 0.4 mg/mL in a multimodal PCEA regimen provides better postoperative pain relief and decreases consumption of analgesics.
  
  
  CONCLUSIONS
  Many studies have evaluated one or a combination of two analgesics for postoperative pain control, but few have examined a multimodal approach using three or four different epidural analgesics. This study demonstrates an additive analgesic effect when ketamine is added to a multimodal analgesic treatment.
authors.affiliation: Department of Anesthesia, Veterans General Hospital-Kaohsiung, Taiwan, Republic of China. yychia@isca.vghks.gov.tw
authors.forename: Y Y
authors.initials: YY
authors.lastname: Chia
authors.forename: K
authors.initials: K
authors.lastname: Liu
authors.forename: Y C
authors.initials: YC
authors.lastname: Liu
authors.forename: H C
authors.initials: HC
authors.lastname: Chang
authors.forename: C S
authors.initials: CS
authors.lastname: Wong
mesh_terms: D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000778:Anesthetics, Dissociative / Q000008:administration & dosage* / Q000009:adverse effects; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects; D003243:Consciousness / Q000187:drug effects; D004311:Double-Blind Method; D004338:Drug Combinations; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007649:Ketamine / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018482:Muscle, Skeletal / Q000187:drug effects; D009325:Nausea / Q000139:chemically induced; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011537:Pruritus / Q000139:chemically induced; D012119:Respiration / Q000187:drug effects; D012893:Sleep Wake Disorders / Q000139:chemically induced; D014662:Vasoconstrictor Agents / Q000008:administration & dosage; D014839:Vomiting / Q000139:chemically induced
chemical_list: D000701:Analgesics, Opioid; D000778:Anesthetics, Dissociative; D000779:Anesthetics, Local; D004338:Drug Combinations; D014662:Vasoconstrictor Agents; D007649:Ketamine; D009020:Morphine; D002045:Bupivacaine; D004837:Epinephrine