title: Remifentanil combined with low-dose ketamine for postoperative analgesia of lower limb fracture: a double-blind, controlled study.
abstract: OBJECTIVE
  To investigate the adjuvant effect of intraoperative and postoperative low-dose ketamine administration to remifentanil consumption in patient-controlled analgesia (PCA) for lower limb fracture.
  
  
  METHODS
  A total of 200 patients with lower limb fracture receiving the surgery were randomly divided into 4 groups. In Groups A, B and C, patients received 0.5 mg/kg ketamine infusion under general anesthesia, and ketamine in a dose of 0.1 mg/ kg, 0.05 mg/kg, 0.01 mg/kg per hour continuously for 24 hours after surgery, respectively. The control group (Group D) received an equivalent volume of normal saline only. With 20 microgram/ml remifentanil in normal saline, postoperative PCA was administered with a background infusion at 2 ml/h following 2 ml as a loading dose and 1ml demand dose with a 3-minute lockout period. Remifentanil consumption, 11-point visual analog scale (VAS) scores, global satisfaction score (GSS), and side effects were also recorded by the acute pain service.
  
  
  RESULTS
  Cumulative PCA remifentanil consumption in Groups A and B were (1378+/-77) microgram and (1531+/-402) microgram, significantly lower than (1807+/-510) microgram and (1838+/-523) microgram in Groups C and D (P<0.01). VAS scores in Groups A and B were significantly lower than those in Groups C and D (P<0.01). In the first 12 hours after operation, GSS was improved (P<0.01). No respiratory depression was observed. No significant difference in side effects was observed among groups.
  
  
  CONCLUSIONS
  Low-dose ketamine can relieve postoperative pain and moderately decrease remifentanil consumption for PCA, with no obvious side effects of ketamine.
authors.affiliation: Department of Anesthesiology, People's Hospital of Badong County, Hubei Province, China.
authors.forename: Gui-feng
authors.initials: GF
authors.lastname: Deng
authors.forename: Jin-ping
authors.initials: JP
authors.lastname: Zheng
authors.forename: Song
authors.initials: S
authors.lastname: Wang
authors.forename: Bin
authors.initials: B
authors.lastname: Tian
authors.forename: Shi-gang
authors.initials: SG
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D016058:Analgesia, Patient-Controlled; D004311:Double-Blind Method; D005260:Female; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D007649:Ketamine / Q000008:administration & dosage*; D035002:Lower Extremity / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy*; D010880:Piperidines / Q000008:administration & dosage*; D000077208:Remifentanil
chemical_list: D010880:Piperidines; D007649:Ketamine; D000077208:Remifentanil