The effect of preemptive ketamine on postoperative analgesia in lower extremity surgery

Havva Esra Uyar Türkyılmaz; Asutay Göktuğ; Handan Güleç; Suna Akın Takmaz; Mustafa Sırrı Kotanoğlu; Sıdıka Ceyhan

doi:10.28982/josam.862547

Authors

Havva Esra Uyar Türkyılmaz Ankara Şehir Hastanesi Anesteziyoloji ve Reanimasyon Kliniği https://orcid.org/0000-0002-5717-3610
Asutay Göktuğ https://orcid.org/0000-0003-0156-0678
Handan Güleç https://orcid.org/0000-0002-3547-9336
Suna Akın Takmaz https://orcid.org/0000-0002-0805-0550
Mustafa Sırrı Kotanoğlu ANKARA İL SAĞLIK MÜDÜRLÜĞÜ https://orcid.org/0000-0002-6906-573X
Sıdıka Ceyhan https://orcid.org/0000-0001-7016-2206

DOI:

https://doi.org/10.28982/josam.862547

Keywords:

Ketamine, Preemptive analgesia, Lornoxicam, Lower extremity orthopedic surgery

Abstract

Background/Aim: Preventing sensitization by an analgesic administered before a painful stimulus is the basis for preemptive analgesia. Preemptive use of pain medication prior to the application of painful stimuli results in better-controlled pain. This study aimed to compare the effects of preoperatively administered low-dose ketamine and lornoxicam on postoperative analgesia, their side effects and patient satisfaction in orthopedic operations on the lower extremities. Methods: Seventy-eight patients aged 18-70 years who were admitted for lower extremity surgery under general anesthesia were enrolled in this prospective, randomized, and double-blind study. The patients were randomly allocated to one of the three following groups: Four milliliters of physiological saline were administered to the patients in Group P, 0.15 mg kg-1 ketamine was given to the patients in Group K and 8 mg lornoxicam was administered to those in Group L, all in 4 ml of volume, intravenously, 15 minutes before anesthesia induction. Postoperative pain was evaluated at rest and during movement at 0th, 2nd, 4th, 6th, 8th, 12th, 20th and 24th postoperative hours with the Visual Analogue Scale (VAS) and the Verbal Pain Scale (VPS). Total fentanyl consumption, additional meperidine usage, side effects and patient satisfaction were recorded at these times. Results: The mean area under the VAS and VPS at rest and movement-time curves were lower in Group K compared to the other groups. Group P and Group L were comparable in terms of the area under the VAS at rest and movement-time curves, but the mean area under the VPS at rest and movement-time curves were higher in Group P compared to Group L. Total fentanyl consumption was lower in Group K than the other two groups (P=0.001). Conclusion: Low-dose ketamine administered preoperatively to patients for lower extremity surgery decreased postoperative pain scores more than lornoxicam or placebo.

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References

Oden R. Acute postoperative pain: incidence, severity and the etiology of inadequate treatment. Anaesthesiol Clin Nam. 1989;7:1-15.

Kehlet H, Dahl JB. The value of “Multimodal” or “Balanced Analgesia” in postoperative pain treatment. Anesth Analg. 1993;77(5):1048-56.

Goodman SB. Multimodal analgesia for orthopedic procedures. Anesth Analg. 2007;105:19-20.

Hannon CP, Keating TC, Lange JK, Ricciardi BJ, Waddell BS, Della Valle JC. Anesthesia and analgesia practices in total joint arthroplasty: a survey of the American association of hip and knee surgeons membership. J Arthroplasty. 2019;34:2872–7.

Wegorowski P, Stanistawek A, Domzat-Drzewicka R, Sysiak J, Rzaca M, Milanowska J, et al. The effect of preemptive analgesia on the level of postoperative pain in women undergoing surgery for breast neoplasm. Contemporary Oncology. 2016;20(2):158-64.

Mowafi HA, Elmakarim EA, Ismail S, Al Mahdy M, El-Saflan AE, Elsaid AS. Intravenous lornoxicam is more effective than paracetamol as a supplemental analgesic after lower abdominal surgery: a randomized controlled study. Worl J Surg. 2012;36:2039-44.

Oliveira C, Issy A, Sakata R, Carcia J, Martins G. Preemptive effect of IV S(+)-ketamine for hysterectomy. Acute Pain. 2005;7:139-43.

Niesters M, Khalili-Mahani N, Martini C, Aarts L van Gerven J, van Buchem M, et al. Effect of subanesthetic ketamine on intrinsic functional brain connectivity: a placebo-controlled functional magnetic resonance imaging study in healthy male volunteers. Anesthesiology. 2012;117(4):868-77.

Wall PD. The prevention of postoperative pain. Pain. 1988;33:289.

Woolf CJ. Somatic pain-pathogenesis and prevention. Br J Anaesth. 1995;75(2):169-76.

Treede RO, Meyer RA, Raja SN. Peripheral and central mechanism of cutaneous hyperalgesia. Progress in Neurobiology. 1992;38:397.

Hillstrom C, Jahobsson J. Lornoxicam: pharmacology and usefulness to treat acute postoperative and musculoskeletal pain a narrative review. Expert Opin.Pharmacother. 2013;14:12.

Karaman S, Gunusen I, Uyar M, Firat V. The effect of pre-operative lornoxicam and ketoprofen application on the morphine consumption of post-operative patient-controlled analgesia. J Int Med Res. 2006;34(2):168-75.

Karaman T, Kuzucuoglu T, Arslan G, Karaman S, Hatun M. Comparison of the analgesic effects of preemptive lornoxicam and paracetamol after laparoscopic cholecystectomy. Int J Anesthetic Anesthesiol. 2016;3:47.

Brau ME, Sander F, Vogel W, Hempelmann G. Blocking mechanisms of ketamine and its enantiomers in enzymatically demyelinated peripheral nerve as revealed by single-channel experiments. Anesthesiology. 1997;86:394-404.

Aida S, Yamakura T, Baba H, Taga K, Fukuda S, Shimoji K. Preemptive analgesia by intravenous low-dose ketamine and epidural morphine in gastrectomy. Anesthesiology. 2000;92:1624-30.

Menigaux C, Fletcher D, Dupont X, Guignard B, Guirimand F, Chauvin M: The benefits of intraoperative small-dose ketamine on postoperative pain after cruciate ligament repair. Anesth Analg. 2000;90:129-35.

Roytblat L, Korotkoruchko A, Katz J, Glazer M, Greemberg L, Fisher A. Postoperative pain: the effect of low-dose ketamine in addition to general anesthesia. Anesth Analg. 1993;77(6):1161-5.

Fu ES, Miguel R, Scharf JE. Preemptive ketamine decreases postoperative narcotic requirements in patients undergoing abdominal surgery. Anesth Analg. 1997;84:1086-90.

Wang P, Yang Z, Shan S, Cao Z, Wang Z. Analgesic effect of perioperative ketamine for total hip arthroplasties and total knee arthroplasties: a PRISMA-compliant meta-analysis. Medicine. 2020;99:42(e228099).

Ozbakis Ç, Akkurt B, Inanoglu K, Kalaci A, Asfuroğlu Z, Tümkaya F. Effects of intravenous small dose ketamine and midazolam on postoperative pain following knee arthroscopy. Pain Pract. 2009;9:289–95.

Miaskowski C. Patient-controlled modalities for acute postoperative pain management. J Perianesthesia Nursing. 2005;20:255-67.

Summers S. Evidence-based practice part 3 acute pain management of the perianesthesia patient. J Perianesthesia Nursing. 2001;16:112-20.

Savaia A, Min JJ, Leber C, Erbacher K, Abrams F, Fink R. Postoperative pain management in elderly patients: correlation between adherence to treatment guidelines and patient satisfaction. J Am Geriatr Soc. 2005;53:274-82.