title: Evaluation the effects of adding ketamine to morphine in intravenous patient-controlled analgesia after orthopedic surgery.
abstract: BACKGROUND
  Intravenous patient-controlled analgesia (PCA) with morphine is commonly used for post-operative pain after major surgery. Ketamine has analgesic property at lower doses, and in combination with opioids it could have synergistic effect. The aim of this study is to determine effects of the addition of ketamine to morphine for PCA after orthopedic surgery.
  
  
  METHODS
  In this double-blind randomized clinical trial, 60 patients were randomly allocated to receive PCA consisting: Group 1 (morphine 0.2 mg/ml), Group 2 (morphine 0.2 mg/ml + ketamine 1 mg/ml), and Group 3 (morphine 0.1 mg/ml + ketamine 2 mg/ml). In this, anesthesiologists managed study, patients had orthopedic surgery. Assessments were made at 24 h and 48 h post-operatively. Visual analog scale (VAS) was used for recording pain score. PCA morphine use was recorded at 24 h and 48 h. VAS scores over 48 h were analyzed with analysis of variance for repeated measures. Significance level was taken as 0.05.
  
  
  RESULTS
  There is no significant difference between demographic information of the three groups (P > 0.05). Control of pain in Group 2 and Group 3 was better than in Group 1 (only morphine) (P = 0.001) but there was no significant difference between Group 2 and Group 3 (P > 0.05). Rate of narcotic consumption in groups 2 and 3 was significantly lower than Group 1 (P < 0.05).
  
  
  CONCLUSIONS
  After orthopedic surgery, the addition of ketamine to morphine for intravenous PCA was superior to Intravenous PCA opioid alone. The combination induces a significant reduction in pain score and cumulative morphine consumption.
authors.affiliation: Department of Anesthesiology, Ardabil University of Medical Sciences, Iran.
authors.forename: Godrat
authors.initials: G
authors.lastname: Akhavanakbari
authors.affiliation: Department of Anesthesiology, Ardabil University of Medical Sciences, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Mohamadian
authors.affiliation: Department of Anesthesiology, Ardabil University of Medical Sciences, Iran.
authors.forename: Masood
authors.initials: M
authors.lastname: Entezariasl
keywords: Intravenous patient-controlled analgesia; ketamine; morphine; orthopedic surgery
references.citation: Anesth Analg. 2005 Jan;100(1):169-174
references.pmid: 15616073
references.citation: Br J Anaesth. 2002 Nov;89(5):697-701
references.pmid: 12393765
references.citation: Chest. 2009 Jul;136(1):245-252
references.pmid: 18753471
references.citation: Can J Anaesth. 1996 Mar;43(3):212-5
references.pmid: 8829857
references.citation: Anesth Analg. 1999 Jul;89(1):98-103
references.pmid: 10389785
references.citation: Ann Fr Anesth Reanim. 2005 Nov-Dec;24(11-12):1349-59
references.pmid: 16115745
references.citation: Anesth Analg. 2001 Jul;93(1):116-20
references.pmid: 11429351
references.citation: Anaesth Intensive Care. 2001 Jun;29(3):246-51
references.pmid: 11439794
references.citation: Pain. 1999 Aug;82(2):111-125
references.pmid: 10467917
references.citation: Eur J Cancer. 2008 May;44(7):954-62
references.pmid: 18396035
references.citation: Anesth Analg. 2000 Jan;90(1):136-41
references.pmid: 10624994
references.citation: Anesthesiology. 2003 Oct;99(4):969-75
references.pmid: 14508333
references.citation: Anesth Analg. 2003 Mar;96(3):789-795
references.pmid: 12598264
references.citation: Br J Anaesth. 1999 Sep;83(3):393-6
references.pmid: 10655908
references.citation: Anesthesiology. 2005 Jul;103(1):147-55
references.pmid: 15983467
references.citation: Acta Anaesthesiol Scand. 2005 Nov;49(10):1405-28
references.pmid: 16223384
references.citation: Eur J Anaesthesiol. 2003 May;20(5):416-21
references.pmid: 12790216
references.citation: Pharmacol Res. 2008 Jul;58(1):38-44
references.pmid: 18602474
references.citation: Acta Anaesthesiol Scand. 1997 Jan;41(1 Pt 2):112-5
references.pmid: 9061093
references.citation: Br J Anaesth. 2007 Sep;99(3):396-403
references.pmid: 17576969
references.citation: Anesth Analg. 2008 Jan;106(1):287-93, table of contents
references.pmid: 18165592
references.citation: Anaesthesia. 2002 May;57(5):484-8
references.pmid: 12004808