title: Transdermal ketamine as an adjuvant for postoperative analgesia after abdominal gynecological surgery using lidocaine epidural blockade.
abstract: We examined the postoperative analgesia of a controlled delivery ketamine transdermal patch after minor abdominal gynecological surgery using lidocaine epidural blockade. Fifty-two patients were randomized to one of two groups. Epidural anesthesia was performed with 25 mL 2% plain lidocaine. At the end of the surgical procedure, a controlled delivery transdermal patch containing either ketamine (25 mg/24 h) (Ketamine group) or placebo (Placebo group) was applied. Pain and adverse effects were assessed hourly postoperatively for 24 h. IM dipyrone was available at patient request. The two groups were demographically similar. The time to first rescue analgesic was longer in the Ketamine group (230+/-112 min) compared with the Placebo group (94+/-54 min); (P<0.00001). There were more dipyrone dose injections in 24 h in the Placebo group compared with the Ketamine group (P<0.0001). The incidence of adverse effects was similar between groups. We conclude that the transdermal-controlled delivery of ketamine prolonged the duration of analgesia after minor gynecological procedures.
  
  
  CONCLUSIONS
  Transdermal delivery of ketamine was an useful adjuvant to postoperative analgesia after epidural lidocaine blockade in the population studied.
authors.affiliation: Faculty of Medicine of Ribeirão Preto-University of São Paulo, São Paulo, Brazil.
authors.forename: V M
authors.initials: VM
authors.lastname: Azevedo
authors.forename: G R
authors.initials: GR
authors.lastname: Lauretti
authors.forename: N L
authors.initials: NL
authors.lastname: Pereira
authors.forename: M P
authors.initials: MP
authors.lastname: Reis
mesh_terms: D000279:Administration, Cutaneous; D000328:Adult; D015360:Analgesia, Epidural; D000779:Anesthetics, Local; D001794:Blood Pressure / Q000187:drug effects; D018691:Excitatory Amino Acid Antagonists / Q000008:administration & dosage* / Q000627:therapeutic use*; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D007649:Ketamine / Q000008:administration & dosage* / Q000627:therapeutic use*; D008012:Lidocaine; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*
chemical_list: D000779:Anesthetics, Local; D018691:Excitatory Amino Acid Antagonists; D007649:Ketamine; D008012:Lidocaine