title: Preincisional subcutaneous infiltration of ketamine suppresses postoperative pain after circumcision surgery.
abstract: OBJECTIVE
  N-methyl-D-aspartate and other glutamate receptors have been shown to present on the peripheral axons of primary afferents, and peripheral injection of N-methyl-D-aspartate-receptor antagonists can suppress hyperalgesia and allodynia. Thus, this study examined postoperative analgesic and adverse effects of local ketamine administered postoperatively.
  
  
  METHODS
  Ketamine (0.3%, 3 mL) or saline was subcutaneously infiltrated before incision in a double-blind manner using a sample population of 40 patients undergoing circumcision surgery, equally and randomly assigned to 2 groups based on the treatment. The saline-infiltrated patients also received 9-mg intramuscular ketamine into the upper arm to control for any related systemic analgesic effects. The patients were followed up for 24 hours to determine postoperative analgesia and identify adverse effects.
  
  
  RESULTS
  In the ketamine-infiltrated patients, the time interval until first analgesic demand (166 vs. 80 min) was longer and the incidence of pain-free status (pain score=0) during movement (45% vs. 10%) and erection (40% vs. 0%) was significantly higher than for the saline-treated analogs (P<0.05). The dose of ketorolac use and pain score during erection were significant lower in group ketamine patients. No significant differences were noted with respect to the incidence of adverse effects comparing the 2 groups.
  
  
  CONCLUSIONS
  We conclude that preincisional subcutaneous ketamine infiltration can suppress postoperative pain after the circumcision surgery.
authors.affiliation: Department of Anesthesiology, E-DA Hospital, I-Shou University, Taiwan, ROC. tanphphd@hotmail.com
authors.forename: Ping-Heng
authors.initials: PH
authors.lastname: Tan
authors.forename: Jiin-Tsuey
authors.initials: JT
authors.lastname: Cheng
authors.forename: Chien-Hung
authors.initials: CH
authors.lastname: Kuo
authors.forename: Feng-Jen
authors.initials: FJ
authors.lastname: Tseng
authors.forename: Han-Chium
authors.initials: HC
authors.lastname: Chung
authors.forename: Jyh-I
authors.initials: JI
authors.lastname: Wu
authors.forename: Hung-Tsung
authors.initials: HT
authors.lastname: Hsiao
authors.forename: Lin-Cheng
authors.initials: LC
authors.lastname: Yang
mesh_terms: D000293:Adolescent; D000328:Adult; D015360:Analgesia, Epidural / Q000379:methods*; D016058:Analgesia, Patient-Controlled / Q000379:methods; D002944:Circumcision, Male / Q000009:adverse effects; D004311:Double-Blind Method; D018691:Excitatory Amino Acid Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007649:Ketamine / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D013997:Time Factors
chemical_list: D018691:Excitatory Amino Acid Antagonists; D007649:Ketamine