[Premedication with intraoperative clonidine and low-dose ketamine in outpatient laparoscopic cholecystectomy].
OBJECTIVE
To determine the efficacy of premedication with intraoperative clonidine in association with low-dose ketamine to reduce the need for postoperative opiate analgesia in outpatient laparoscopic cholecystectomy.


METHODS
We performed a prospective study of patients undergoing outpatient laparoscopic cholecystectomy between November 2005 and November 2006. The patients were distributed randomly in 2 groups: patients in the clonidine-ketamine group received clonidine (0.15 mg orally 60 minutes before surgery) and ketamine (20-mg intravenous bolus followed by intraoperative perfusion of 20 mg h(-1)); patients in the control group did not receive this medication. Pain assessed on a verbal numerical scale, number of times rescue analgesia was required to achieve a value below 3, and adverse effects of the medication were recorded in the postoperative period.


RESULTS
Thirty-one patients (16 in the clonidine-ketamine group and 15 in the control group) were enrolled. Rescue analgesia was required on 2 occasions by 25% of patients in the clonidine-ketamine group and on 2 or 3 occasions by 533% of patients in the control group. Adverse effects were reported by 87.5% of patients in the clonidine-ketamine group (mainly visual disturbances, sedation, and nausea) and by 46.7% in the control group. This difference was significant during the patients' stay in the postanesthesia recovery unit.


CONCLUSIONS
Patients receiving clonidine and ketamine required less additional opiate analgesia to achieve mild pain values (<3 on the numerical verbal scale) but suffered more adverse effects during their stay in the postanesthesia recovery unit. Discharge was not delayed, however.
Servicio de Anestesia, Hospital de Laredo, Laredo, Cantabria. mgalindopalazuelos@yahoo.es
M
M
Galindo Palazuelos
N A
NA
Díaz Setién
P
P
Rodríguez Cundín
F J
FJ
Manso Marín
A
A
Castro Ugalde
D000556:Ambulatory Surgical Procedures; D000700:Analgesics / Q000008:administration & dosage*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D003000:Clonidine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D007649:Ketamine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology* / Q000517:prevention & control*; D011229:Preanesthetic Medication; D011446:Prospective Studies
D000700:Analgesics; D000701:Analgesics, Opioid; D007649:Ketamine; D003000:Clonidine
Premedicación con clonidina y ketamina intraoperatoria a bajas dosis en la colecistectomía laparoscópica ambulatoria.