Ketamine does not decrease postoperative pain after remifentanil-based anaesthesia for tonsillectomy in adults.
BACKGROUND
There are conflicting results concerning the pre-emptive effect of ketamine on central sensitization following surgery. The aim of this prospective, randomized, double-blind, placebo-controlled study was to assess the effect of the N-methyl-D-aspartate receptor antagonist ketamine on postoperative morphine consumption and pain score after remifentanil-based anaesthesia in adult patients scheduled for tonsillectomy.


METHODS
We studied 40 adult patients undergoing elective tonsillectomy. Total intravenous anaesthesia was induced and maintained with remifentanil (0.125-1.0 microg kg(-1) min(-1)) and propofol target-controlled infusion. Patients in group K received a bolus dose of ketamine 0.5 mg kg(-1) immediately after anaesthetic induction, followed by a continuous infusion of 2 microg kg(-1) min(-1). Saline was administered in the same sequence in group S. Propofol, remifentanil, and the study drug infusions were discontinued at the end of surgery.


RESULTS
Intraoperative remifentanil consumption (0.57 +/- 0.18 in group K vs. 0.55 +/- 0.14 microg kg(-1) min(-1) in group S), morphine requirement in the PACU (11 +/- 3 in group K vs. 9 +/- 4 mg in group S) and in the ward (22 +/- 11 in group K vs. 25 +/- 14 mg in group S), median time to first analgesia in the ward (338 +/- 126 in group K vs. 328 +/- 144 min in group S), and VAS pain scores were comparable in both groups.


CONCLUSIONS
Small-dose of ketamine does not seem to be a useful adjunct to remifentanil-based anaesthesia during short, painful surgical procedures.
Van Elstraete
A C
AC
Department of Anaesthesiology, Saint-Paul Medical Center, Fort-de-France, Martinique, FWI. alainvanel@hotmail.com
Lebrun
T
T
Sandefo
I
I
Polin
B
B
D000328:Adult; D000700:Analgesics / Q000494:pharmacology; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000704:Analysis of Variance; D000771:Anesthesia, Intravenous / Q000379:methods*; D018686:Anesthetics, Intravenous / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007649:Ketamine / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D010146:Pain / Q000503:physiopathology*; D010147:Pain Measurement / Q000379:methods; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D010880:Piperidines / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000503:physiopathology*; D011446:Prospective Studies; D000077208:Remifentanil; D012965:Sodium Chloride / Q000008:administration & dosage; D013997:Time Factors; D014068:Tonsillectomy / Q000009:adverse effects / Q000379:methods*
D000700:Analgesics; D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D010880:Piperidines; D012965:Sodium Chloride; D007649:Ketamine; D009020:Morphine; D000077208:Remifentanil