title: A randomized, controlled trial of a clinical pharmacist intervention in microdiscectomy surgery - Low dose intravenous ketamine as an adjunct to standard therapy.
abstract: OBJECTIVE
  The hypothesis that postoperative pain would be reduced by using 1 μg/kg/min of ketamine, both intra- and post-operatively, for lumbar microdiscectomy surgery was assessed by measuring morphine consumption. Patient side effects were reported.
  
  
  METHODS
  Forty-five patients undergoing microdiscectomy surgery were randomized under double-blind conditions into three groups: Group1 (G1) received normal saline, Group 2 (G2) ketamine (1 μg/kg/min) intra-operatively and Group 3 (G3) ketamine (1 μg/kg/min) both intra- and post-operatively. Morphine consumption, pain scores, nausea and vomiting, CNS disorders were recorded for 24 h post surgery. This study was conducted by applying the concept of a clinical pharmacist intervention.
  
  
  RESULTS
  The time for the first analgesia demand dose was significantly shorter (P < 0.05) in G117 ± 1.7 min than for G2 and G3. In G3 morphine consumption 6, 12, and 24 h after surgery was 3 ± 2.26, 9.2 ± 2.11 and 26.9 ± 2.71 mg. Total morphine consumption was significantly lower for G3 than for G1 or G2 (P < 0.05). The visual analog scale score (VAS) values were significantly lower in G3 (P < 0.05) than for the other groups during the first 24 h. The rate of nausea and vomiting was significantly higher in G1 vs G3 (P < 0.05). No difference in drug induced CNS disturbances was observed among the groups.
  
  
  CONCLUSIONS
  Using 1 μg/kg/min of ketamine hydrochloride intra- and post-operatively for microdiscectomy surgery could be an adjunct therapy to reduce postoperative morphine consumption minimizing its side effects. Collaborative clinical pharmacy practice on the basis of pharmacology had an effective role in improving the general outcome of microdiscectomy surgery.
authors: Faculty of Pharmacy, Philadelphia University, P.O. Box 1, Amman 19392, Jordan.
authors: Bushra A
authors: BA
authors: Hadi
authors: Rafat
authors: R
authors: Daas
authors: Romána
authors: R
authors: Zelkó
keywords: Intra-operative; Ketamine; Microdiscectomy surgery; Morphine consumption; Nausea and vomiting; Post-operative
references: JAMA. 1997 Jan 22-29;277(4):301-6
references: 9002492
references: Anesthesiology. 2005 Jan;102(1):211-20
references: 15618805
references: J Perianesth Nurs. 2003 Feb;18(1):32-41
references: 12596132
references: Anesth Analg. 2005 Feb;100(2):475-480
references: 15673878
references: Acta Anaesthesiol Scand. 2005 Nov;49(10):1405-28
references: 16223384
references: Minerva Anestesiol. 2011 Feb;77(2):239; author reply 240-1
references: 21368730
references: Patient Prefer Adherence. 2012;6:323-9
references: 22563240
references: Anesth Analg. 2007 Apr;104(4):912-7
references: 17377106
references: Int J Clin Pharmacol Ther. 2010 Aug;48(8):542-8
references: 20650046
references: Ann Pharmacother. 2008 Sep;42(9):1195-207
references: 18682540
references: BMJ. 1997 May 24;314(7093):1531-5
references: 9183203
references: Anesth Analg. 1998 Jun;86(6):1245-9
references: 9620513
references: Br J Anaesth. 2003 May;90(5):665-70
references: 12697596
references: Pain Res Manag. 2011 Jan-Feb;16(1):19-26
references: 21369537
references: Can J Anaesth. 1996 Mar;43(3):212-5
references: 8829857
references: Anesth Analg. 2008 Jun;106(6):1856-61
references: 18499623
references: Anesth Analg. 2003 Sep;97(3):843-847
references: 12933413
references: HSS J. 2008 Feb;4(1):62-5
references: 18751864
references: Mol Pain. 2009 Dec 30;5:76
references: 20042082
references: Drugs. 2000 Feb;59(2):213-43
references: 10730546
references: Neurosurgery. 2002 Mar;50(3):518-24; discussion 524-5
references: 11841719
references: Anesth Analg. 1997 Jul;85(1):135-8
references: 9212136
references: Spine (Phila Pa 1976). 1999 Sep 15;24(18):1958-60
references: 10515023
references: Nan Fang Yi Ke Da Xue Xue Bao. 2011 Feb;31(2):338-40
references: 21354925
references: Pain. 1999 Aug;82(2):111-125
references: 10467917
references: Br J Clin Pharmacol. 1999 Jun;47(6):667-73
references: 10383545
references: Pak J Pharm Sci. 2006 Jan;19(1):65-72
references: 16632457
references: Anaesthesia. 2004 Mar;59(3):222-8
references: 14984518