title: Postoperative pain relief after hepatic resection in cirrhotic patients: the efficacy of a single small dose of ketamine plus morphine epidurally.
abstract: In cirrhotic patients undergoing hepatic surgery, postoperative analgesia remains a challenge. In this study, we evaluated the efficacy of a single dose of morphine combined with small-dose ketamine given epidurally for postoperative pain relief. One-hundred-four classification "Child A" cirrhotic patients were randomly assigned to two groups: 1) (MKG, n = 54): epidural morphine (3.5-5 mg) plus ketamine (20/30 mg); and 2) epidural morphine (3.5/5 mg) (MG, n = 50). The level of analgesia, side effects, psychomimetic and neurological disorders, additional analgesic needs, and overall quality of the analgesia were recorded. The mean duration of analgesia was longer in the MKG group (27.2 +/- 8 h versus 16.4 +/- 10 h; P < 0.05). In the MKG group, the visual analog scale (VAS) score began to be significantly lower from 14 h at rest and 12 h on coughing until the end of the study. The need for additional analgesia was also smaller in the MKG group (P < 0.05): at 24 h, only 10% of patients in the MKG group needed complementary analgesia, whereas in the MG group it was 100% (P = 0.003). Side effects were similar in both groups. Psychomimetic side effects and neurological disorders were not detected. These results suggest that postoperative analgesia provided by a single dose of epidural morphine with small-dose ketamine is effective in cirrhotic Child's A patients having major upper abdominal surgery.
authors.affiliation: Department of Anesthesiology, Universitat de Barcelona, Hospital Clínic, Barcelona, Spain. ptaura@clinic.ub.es
authors.forename: Pilar
authors.initials: P
authors.lastname: Taurá
authors.forename: Josep
authors.initials: J
authors.lastname: Fuster
authors.forename: Anabel
authors.initials: A
authors.lastname: Blasi
authors.forename: Julia
authors.initials: J
authors.lastname: Martinez-Ocon
authors.forename: Teresa
authors.initials: T
authors.lastname: Anglada
authors.forename: Joan
authors.initials: J
authors.lastname: Beltran
authors.forename: Jaume
authors.initials: J
authors.lastname: Balust
authors.forename: Javier
authors.initials: J
authors.lastname: Tercero
authors.forename: Juan-Carlos
authors.initials: JC
authors.lastname: Garcia-Valdecasas
mesh_terms: D000082:Acetaminophen / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural; D000700:Analgesics / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000778:Anesthetics, Dissociative / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000601:surgery; D005260:Female; D006801:Humans; D007649:Ketamine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008099:Liver / Q000601:surgery*; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery*; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D017060:Patient Satisfaction; D011446:Prospective Studies
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D000778:Anesthetics, Dissociative; D000082:Acetaminophen; C063776:propacetamol; D007649:Ketamine; D009020:Morphine; D008691:Methadone