Erik Dong, D.O.
Article:
Intraoperative Small-Dose Ketamine Enhances Analgesia
After
Outpatient Knee Arthroscopy
Christophe Menigaux, MD, Bruno Guignard, MD, Dominique Fletcher, MD,
Daniel I. Sessler, MD, Xavier Dupont, MD, and Marcel Chauvin, MD
(AnesthAnalg 2001;93:606–12)
Summary:
Ketamine is a NMDA
channel blocker that has been increasingly analyzed for its uses within the
multimodal approach to preemptive analgesia and post operative narcotic use.
This double blinded, randomized study aims to correlate the use of ketamine at
the time of induction, to post op pain, necessity for additional pain medication
and ability to ambulate in patients undergoing outpatient knee arthroscopy with
meniscal repair. Patients were subjected to similar inclusion and exclusion
criteria and placed into groups of 25 (control vs ketamine 0.15mg/kg) with
similar management of general anesthesia and surgical technique.
The findings demonstrated that the
ketamine experimental group required less post operative morphine in the PACU
and less Di-Antalvac (400 mg acetaminophen and 30 mg dextropropoxyphene;
Aventis, Inc., Montrouge, France) in the ambulatory setting, further distances
with ambulation with minimal to no direct adverse affects attributed to
ketamine. Unlike previous ketamine studies, this particular one suggests that
ketamine may aid in post operative analgesia for long durations, as its
beneficial effects were seen for up to three days post surgery.
It has been suggested by
the authors that ketamine preemptively blocks analgesia by various mechanisms.
First it works by prevention of the development of neuronal hyperexcitability
within the central nervous system, distinct and independent of peripheral opiod
receptors. Another potential method being potentiation and synergism between
the NMDA antagonist and NSAIDS. Overall this a well designed study which shows
the benefit of small doses of ketamine in a multimodal approach to surgical
analgesia.
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