title: No morphine sparing effect of ketamine added to morphine for patient-controlled intravenous analgesia after uterine artery embolization.
abstract: BACKGROUND
  Pain following embolization of the uterine arteries (UAEs) is variable and may be very severe requiring large doses of parenteral opioids for relief. The present study tested the hypothesis that the addition of ketamine to i.v. patient-controlled morphine reduces the amount of morphine required for pain-control during the first 24 h after UAE embolization.
  
  
  METHODS
  Fifty-six patients undergoing UAE embolization for treatment of symptomatic uterine leiomyomata were randomized to receive either 2 mg/ml of morphine (Control group, n=30) or 2 mg/ml of both morphine and ketamine (Ketamine group, n=26) by i.v. patient-controlled analgesia (IV-PCA). Pump settings were bolus dose 1 ml, lockout 10 min, no background infusion. In addition, all patients received diclofenac and acetaminophen for pain relief. Pain scores, morphine consumption and adverse events like nausea, vomiting, itching, visual disturbances, anxiety, dreaming and hallucinations, if any, were recorded for 24 h after embolization.
  
  
  RESULTS
  The mean +/- SD 24-h consumption of patient-controlled morphine was 38.3 +/- 21.0 mg in the Ketamine group vs. 33.3 +/- 18.3 mg in the Control group (NS). The difference between the means was 5.0 mg (95% confidence interval: -5.7; 15.6). One patient in the Ketamine group vs. none in the Control group experienced auditory hallucinations.
  
  
  CONCLUSIONS
  Studying an unselected group of patients undergoing embolization of the UAEs for treatment of symptomatic uterine leiomyomata under conditions of basal analgesia with acetaminophen and diclofenac, we failed to demonstrate any morphine-sparing effect of IV-PCA ketamine and morphine compared with IV-PCA morphine alone.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Odense University Hospital, DK-5000 Odense C, Denmark. luana@dadlnet.dk
authors.forename: L L
authors.initials: LL
authors.lastname: Jensen
authors.forename: G
authors.initials: G
authors.lastname: Handberg
authors.forename: H S
authors.initials: HS
authors.lastname: Helbo-Hansen
authors.forename: I
authors.initials: I
authors.lastname: Skaarup
authors.forename: T
authors.initials: T
authors.lastname: Lohse
authors.forename: T
authors.initials: T
authors.lastname: Munk
authors.forename: N
authors.initials: N
authors.lastname: Lund
mesh_terms: D000328:Adult; D000698:Analgesia / Q000009:adverse effects / Q000379:methods; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects / Q000379:methods*; D000700:Analgesics / Q000009:adverse effects / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D007649:Ketamine / Q000009:adverse effects / Q000627:therapeutic use*; D007889:Leiomyoma / Q000628:therapy*; D008875:Middle Aged; D009020:Morphine / Q000009:adverse effects / Q000627:therapeutic use*; D010147:Pain Measurement / Q000706:statistics & numerical data; D010149:Postoperative Pain / Q000188:drug therapy*; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000628:therapy*; D014599:Uterus / Q000098:blood supply
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D007649:Ketamine; D009020:Morphine