Beneficial effects of adding ketamine to intravenous patient-controlled analgesia with fentanyl after the Nuss procedure in pediatric patients.
OBJECTIVE
The aim of this prospective, double-blind, randomized study was to investigate the analgesic effects of low-dose ketamine on intravenous patient-controlled analgesia (IV-PCA) with fentanyl for pain control in pediatric patients following the Nuss procedure for pectus excavatum.


METHODS
Sixty pediatric patients undergoing the Nuss procedure were randomly assigned to receive fentanyl (Group F, n=30) or fentanyl plus ketamine (Group FK, n=30). Ten minutes before the end of surgery, following the loading dose of each solution, 0.5 μg/kg/hr of fentanyl or 0.5 μg/kg/hr of fentanyl plus 0.15 mg/kg/hr of ketamine was infused via an IV-PCA pump (basal rate, 1 mL/hr; bolus, 0.5 mL; lock out interval, 30 min). Fentanyl consumption, pain score, ketorolac use, nausea/vomiting, ondansetron use, pruritus, respiratory depression, hallucination, dreaming, and parent satisfaction with pain control were measured throughout the 48 hours following surgery.


RESULTS
The pain scores, ketorolac use, and fentanyl consumption of Group FK were significantly lower than in Group F (p<0.05). The incidence of nausea/vomiting and ondansetron use in Group FK was significantly lower than in Group F (p<0.05). There were no reports of respiratory depression, hallucination or dreaming. Parent satisfaction with pain control was similar between the two groups.


CONCLUSIONS
We concluded that low-dose ketamine added to IV-PCA with fentanyl after the Nuss procedure in pediatric patients can reduce pain scores, consumption of fentanyl, and incidence of nausea/vomiting without increasing side effects.
Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea.
Moon Ho
MH
Cha
Ji Hye
JH
Eom
Yoon Sook
YS
Lee
Woon Young
WY
Kim
Young Cheol
YC
Park
Sam Hong
SH
Min
Jae Hwan
JH
Kim
D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000700:Analgesics / Q000627:therapeutic use*; D002648:Child; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use*; D005660:Funnel Chest / Q000601:surgery; D006801:Humans; D007275:Injections, Intravenous; D007649:Ketamine / Q000627:therapeutic use*; D008297:Male; D010149:Postoperative Pain / Q000188:drug therapy
D000700:Analgesics; D007649:Ketamine; D005283:Fentanyl