title: Evaluation of preemptive effect of epidural S(+)-ketamine for hysterectomy: plasmatic concentrations of interleukins.
abstract: OBJECTIVE
  Some studies showed that ketamine inhibits the production of cytokines. The objective of this study was to evaluate the preemptive analgesic effect of epidural S(+)-ketamine in hysterectomy and plasmatic cytokines (IL-6, TNF-α and IL-10).
  
  
  METHODS
  A double-blinded study with 29 patients was conducted. Patients in Group 1 received 13 mL of 0.25% bupivacaine with 25mg of S(+)- ketamine 30 minutes before surgical incision and 15 mL of saline solution via the epidural route 30 minutes after. Patients in Group 2 received 15 mL of saline solution 30 minutes before the surgical incision, followed by 13 mL of 0.25% bupivacaine with 25mg of S(+)-ketamine 30 minutes after. Postoperative analgesia was made with epidural bupivacaine and fentanyl. Dipyrone 1 g was used whenever required. The following paramenters were evaluated: concentration of cytokines, intensity of pain, time of first request of analgesic and total quantity of analgesic used.
  
  
  RESULTS
  Time for the first request for analgesics was 61.5 minutes in Group 1 and 69.0 in Group 2, without difference between these groups. There was no difference for total dose of fentanyl used in Group 1 (221.4 μg) and Group 2 (223.3 μg). A similar analgesic effect was obtained in both groups, except in T12 (Group 1 = 2.4±3.2; Group 2 = 5.5±3.4). No differences in concentration of cytokines were observed.
  
  
  CONCLUSIONS
  The epidural injection of 25mg S(+)-ketamine before incision reduced the pain intensity only 12 hours after surgical incision and did not alter concentration of cytokines.
authors.affiliation: Universidade Federal de São Paulo (UNIFESP), Brazil.
authors.forename: Elismar Paulo Azevedo
authors.initials: EP
authors.lastname: Silva
authors.forename: Rioko Kimiko
authors.initials: RK
authors.lastname: Sakata
authors.forename: João Batista Santos
authors.initials: JB
authors.lastname: Garcia
authors.forename: Reinaldo
authors.initials: R
authors.lastname: Salomão
authors.forename: Adriana Machado
authors.initials: AM
authors.lastname: Issy
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural; D000700:Analgesics / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007044:Hysterectomy; D016753:Interleukin-10 / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood*; D007649:Ketamine / Q000008:administration & dosage*; D010149:Postoperative Pain / Q000097:blood* / Q000517:prevention & control*; D011446:Prospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*
chemical_list: D000700:Analgesics; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; D007649:Ketamine