title: Prospective, randomized, and controlled trial on ketamine infusion during bilateral axillo-breast approach (BABA) robotic or endoscopic thyroidectomy: Effects on postoperative pain and recovery profiles: A consort compliant article.
abstract: BACKGROUND
  Robotic or endoscopic thyroidectomy using bilateral axillo-breast approach (BABA) is frequently performed for excellent cosmesis. However, postoperative pain is remained as concerns due to the extent tissue dissection and tension during the operation. Ketamine is a noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist that reduces acute postoperative pain. We evaluated the effects of intraoperative ketamine infusion on postoperative pain control and recovery profiles following BABA robotic or endoscopic thyroidectomy.
  
  
  METHODS
  Fifty-eight adult patients scheduled for BABA robotic or endoscopic thyroidectomy were randomized into a control group (n = 29) and ketamine group (n = 29). Following induction of anesthesia, patients in each group were infused with the same volume of saline or ketamine solution (1 mg/kg bolus, 60 μg/kg/h continuous infusion). Total intravenous anesthesia with propofol and remifentanil was used to induce and maintain anesthesia. Pain scores (101-point numerical rating scale, 0 = no pain, 100 = the worst imaginable pain), the consumption of rescue analgesics, and other postoperative adverse effects were assessed at 1, 6, 24, and 48 hours postoperatively.
  
  
  RESULTS
  Patients in the ketamine group reported lower pain scores than those in the control group at 6 hours (30 [30] vs 50 [30]; P = 0.017), 24 hours (20 [10] vs 30 [20]; P < 0.001), and 48 hours (10 [10] vs 20 [15]; P < 0.001) in neck area. No statistically significant differences were found between the 2 groups in terms of the requirements for rescue analgesics or the occurrence of adverse events.
  
  
  CONCLUSIONS
  Intravenous ketamine infusion during anesthesia resulted in lower postoperative pain scores following BABA robotic or endoscopic thyroidectomy, with no increase in adverse events.
authors.affiliation: Department of Anesthesiology & Pain Medicine, Seoul National University College of Medicine Department of Anesthesiology & Pain Medicine, Seoul National University Hospital, Seoul Department of Surgery Department of Anesthesiology & Pain Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea.
authors.forename: Dong-Ho
authors.initials: DH
authors.lastname: Kim
authors.forename: June Young
authors.initials: JY
authors.lastname: Choi
authors.forename: Byoung-Gook
authors.initials: BG
authors.lastname: Kim
authors.forename: Jin-Young
authors.initials: JY
authors.lastname: Hwang
authors.forename: Seong-Joo
authors.initials: SJ
authors.lastname: Park
authors.forename: Ah-Young
authors.initials: AY
authors.lastname: Oh
authors.forename: Young-Tae
authors.initials: YT
authors.lastname: Jeon
authors.forename: Jung-Hee
authors.initials: JH
authors.lastname: Ryu
mesh_terms: D000328:Adult; D000700:Analgesics / Q000008:administration & dosage*; D004724:Endoscopy; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007649:Ketamine / Q000008:administration & dosage*; D008297:Male; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies; D020127:Recovery of Function; D065287:Robotic Surgical Procedures; D013965:Thyroidectomy; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D007649:Ketamine