The effects of small-dose ketamine on morphine consumption in surgical intensive care unit patients after major abdominal surgery.
In a randomized, double-blinded study, we evaluated the analgesic effect of ketamine in the management of pain in a surgical intensive care unit after major abdominal surgery. Patients received morphine patient-controlled analgesia with either placebo (Group M) or ketamine (Group K). Morphine was administered with initial loading doses of 2 mg until the visual analog scale (VAS) score was <30 and thereafter with bolus doses of 1 mg and a lockout time of 7 min. Ketamine was administered with an initial bolus of 0.5 mg/kg followed by a perfusion of 2 micro g x kg(-1) x min(-1) during the first 24 h and 1 micro g x kg(-1) x min(-1) during the following 24 h. The 4-h cumulative morphine doses were measured over 48 h. The VAS scores at rest and at mobilization were measured every 4 h during 48 h. A total of 101 patients were enrolled, and 93 were analyzed (41 in Group K and 52 in Group M). VAS scores at rest and at mobilization were similar. The cumulative consumption of morphine was significantly smaller in Group K (P < 0.05). We concluded that small doses of ketamine were a valuable adjunct to opioids in surgical intensive care unit patients after major abdominal surgery.
Guillou
Nicolas
N
*Surgical Intensive Care Unit, †Biostatistical Unit, and ‡Surgical Unit, Hôpital Pontchaillou, Rennes, France.
Tanguy
Michèle
M
Seguin
Philippe
P
Branger
Bernard
B
Campion
Jean-Pierre
JP
Mallédant
Yannick
Y
D000005:Abdomen / Q000601:surgery; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000778:Anesthetics, Dissociative / Q000008:administration & dosage / Q000627:therapeutic use*; D003422:Critical Care; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007649:Ketamine / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies
D000701:Analgesics, Opioid; D000778:Anesthetics, Dissociative; D007649:Ketamine; D009020:Morphine