Remifentanil in combination with ketamine versus remifentanil in spinal fusion surgery--a double blind study.
OBJECTIVE
This study is aimed at conducting a program for two different anesthetic methods used during a spinal fusion surgery to ensure better intra-operative hemodynamic stability and post-operative pain control.


METHODS
A prospective, randomized, double blind study in patients scheduled for spinal fusion surgery, who were randomly allocated to two groups, G1 and G2, (n = 15 per group), class I-II ASA, was carried out. Both groups received pre-operatively midazolam, followed intra-operatively by propofol, sevoflurane, atracurium, and either remifentanil infusion 0.2 microg/kg/min (G1), or the same dose of remifentanil infusion and low doses of ketamine infusion 1 microg/kg/min (G2) anesthetics, antidote medication and post-operative morphine doses. HR, MAP, vital signs, surgical bleeding, urine output, duration of surgery and duration of anesthesia were recorded. In a 24-h recovery period in a post-anesthesia care unit (PACU) the recovery time, the first pain score and analgesic requirements were measured.


RESULTS
Intra-operative HR and arterial BP were significantly less (p < 0.05) in G1 as compared to G2. In the PACU the first pain scores were significantly less (p < 0.05) in G2 than in G1. The time for the first patient analgesia demand dose was greater in G2, as also morphine consumption which was greater in G1 than G2 (p < 0.05). Other results were the same. None of the patients had any adverse drug reaction.


CONCLUSIONS
Adding low doses of ketamine hydrochloride could be a routine therapy to improve the hemodynamic stability and reduce the post-operative morphine consumption during spinal fusion surgery.
Hadi
B A
BA
Faculty of Pharmacy, Philadelphia University, 2Arab Medical Center, Amman, Jordan. Bushra_abdul@yahoo.com
Al Ramadani
R
R
Daas
R
R
Naylor
I
I
Zelkó
R
R
D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000762:Anesthesia Recovery Period; D019162:Anesthetics, Combined / Q000627:therapeutic use*; D000778:Anesthetics, Dissociative / Q000627:therapeutic use; D018686:Anesthetics, Intravenous / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007649:Ketamine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D010149:Postoperative Pain / Q000188:drug therapy; D010880:Piperidines / Q000627:therapeutic use*; D011446:Prospective Studies; D000077208:Remifentanil; D013123:Spinal Fusion / Q000379:methods*
D000701:Analgesics, Opioid; D019162:Anesthetics, Combined; D000778:Anesthetics, Dissociative; D018686:Anesthetics, Intravenous; D010880:Piperidines; D007649:Ketamine; D009020:Morphine; D000077208:Remifentanil