The Comparison of Preventive Analgesic Effects of Ketamine, Paracetamol and Magnesium Sulfate on Postoperative Pain Control in Patients Undergoing Lower Limb Surgery: A Randomized Clinical Trial

Seyed Morteza Heydari, Seyed Jalal Hashemi, Shahpour Pourali, Seyed Morteza Heydari, Seyed Jalal Hashemi, Shahpour Pourali

Abstract

Background: In considering the importance of postoperative pain management and its consequences on its related secondary outcomes including nausea, vomiting, and operation-related complications, we aimed to compare the effectiveness of the three analgesic agents including ketamine, paracetamol, and magnesium sulfate for postoperative pain relief and associated consequences in this trial.

Materials and methods: In this double-blinded randomized control clinical trial, patients scheduled for elective lower extremity orthopedic surgery under general anesthesia were enrolled and randomized into four groups for receiving intravenous ketamine (0.25 mg/kg), paracetamol (15 mg/kg), magnesium sulfate (7.5 mg/kg), and placebo (normal saline), immediately after the induction of anesthesia. Postoperative pain scores, analgesic, and metoclopramide use, and frequency of vomiting and satisfaction score of studied patients in the four studied groups during the 6 h, 6-12 h, and 12-24 h after recovery were recorded and compared.

Results: In this trial, thirty patients randomized in each studied groups. Mean of postoperative pain score was significantly lower in ketamine group than others during 24 h after recovery (P < 0.001). Mean of additive analgesic use was significantly lower in ketamine group during 12 h after recovery (P < 0.001), but it was not significantly different during 12-24 h after recovery (P = 0.12). Mean of vomiting frequency and metoclopramide use was not different between groups (P > 0.05). Excellent and good satisfaction score were significantly higher in ketamine group than other groups (P = 0.04).

Conclusions: Ketamine has more superior effect for during recovery and postoperative pain controlling and analgesic use than paracetamol and magnesium sulfate.

Keywords: Ketamine; paracetamol and magnesium sulfate; postoperative pain; preemptive analgesia.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Consort diagram of the study
Figure 2
Figure 2
Mean of postoperative pain (visual analog scale) (a), vomiting (b) analgesic (c) and metoclopramid use (d) during the 6 h, 6–12 h and 12–24 h after recovery in ketamine, paracetamol, magnesium sulfate and control groups
Figure 3
Figure 3
Frequency of different scores of patients satisfaction (excellent, good, moderate, week),24 hours after recovery, in ketamine, paracetamol, magnesium sulfate and control groups

References

    1. Vadivelu N, Mitra S, Schermer E, Kodumudi V, Kaye AD, Urman RD. Preventive analgesia for postoperative pain control: A broader concept. Local Reg Anesth. 2014;7:17–22.
    1. Carr DB, Goudas LC. Acute pain. Lancet. 1999;353:2051–8.
    1. Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: Results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003;97:534–40.
    1. Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery. Lancet. 2003;362:1921–8.
    1. Holte K, Kehlet H. Postoperative ileus: A preventable event. Br J Surg. 2000;87:1480–93.
    1. Gandhi K, Heitz JW, Viscusi ER. Challenges in acute pain management. Anesthesiol Clin. 2011;29:291–309.
    1. American Society of Anesthesiologists Task Force on Acute Pain Management. Practice guidelines for acute pain management in the perioperative setting: An updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology. 2012;116:248–73.
    1. Lucas CE, Vlahos AL, Ledgerwood AM. Kindness kills: The negative impact of pain as the fifth vital sign. J Am Coll Surg. 2007;205:101–7.
    1. Taylor RS, Ullrich K, Regan S, Broussard C, Schwenkglenks M, Taylor RJ, et al. The impact of early postoperative pain on health-related quality of life. Pain Pract. 2013;13:515–23.
    1. Ong CK, Lirk P, Seymour RA, Jenkins BJ. The efficacy of preemptive analgesia for acute postoperative pain management: A meta-analysis. Anesth Analg. 2005;100:757–73.
    1. Hariharan S, Moseley H, Kumar A, Raju S. The effect of preemptive analgesia in postoperative pain relief – A prospective double-blind randomized study. Pain Med. 2009;10:49–53.
    1. Dullenkopf A, Müller R, Dillmann F, Wiedemeier P, Hegi TR, Gautschi S. An intraoperative pre-incision single dose of intravenous ketamine does not have an effect on postoperative analgesic requirements under clinical conditions. Anaesth Intensive Care. 2009;37:753–7.
    1. Koh W, Nguyen KP, Jahr JS. Intravenous non-opioid analgesia for peri- and postoperative pain management: A scientific review of intravenous acetaminophen and ibuprofen. Korean J Anesthesiol. 2015;68:3–12.
    1. Han JU. About uses of magnesium during perioperative period. Korean J Anesthesiol. 2012;62:509–11.
    1. Jouguelet-Lacoste J, La Colla L, Schilling D, Chelly JE. The use of intravenous infusion or single dose of low-dose ketamine for postoperative analgesia: A review of the current literature. Pain Med. 2015;16:383–403.
    1. Albrecht E, Kirkham KR, Liu SS, Brull R. Peri-operative intravenous administration of magnesium sulphate and postoperative pain: A meta-analysis. Anaesthesia 2013. 2013;68:79–90.
    1. Sinatra RS, Jahr JS, Reynolds LW, Viscusi ER, Groudine SB, Payen-Champenois C. Efficacy and safety of single and repeated administration of 1 gram intravenous acetaminophen injection (paracetamol) for pain management after major orthopedic surgery. Anesthesiology. 2005;102:822–31.
    1. Gregoire N, Hovsepian L, Gualano V, Evene E, Dufour G, Gendron A. Safety and pharmacokinetics of paracetamol following intravenous administration of 5 g during the first 24 h with a 2-g starting dose. Clin Pharmacol Ther. 2007;81:401–5.
    1. Brodner G, Gogarten W, Van Aken H, Hahnenkamp K, Wempe C, Freise H, et al. Efficacy of intravenous paracetamol compared to dipyrone and parecoxib for postoperative pain management after minor-to-intermediate surgery: A randomised, double-blind trial. Eur J Anaesthesiol. 2011;28:125–32.
    1. De Oliveira GS, Jr, Castro-Alves LJ, Khan JH, McCarthy RJ. Perioperative systemic magnesium to minimize postoperative pain: A meta-analysis of randomized controlled trials. Anesthesiology. 2013;119:178–90.
    1. Rezae M, Naghibi K, Taefnia AM. Effect of pre-emptive magnesium sulfate infusion on the post-operative pain relief after elective cesarean section. Adv Biomed Res. 2014;3:164.
    1. Dabbagh A, Elyasi H, Razavi SS, Fathi M, Rajaei S. Intravenous magnesium sulfate for post-operative pain in patients undergoing lower limb orthopedic surgery. Acta Anaesthesiol Scand. 2009;53:1088–91.
    1. Shariat Moharari R, Motalebi M, Najafi A, Zamani MM, Imani F, Etezadi F, et al. Magnesium can decrease postoperative physiological ileus and postoperative pain in major non laparoscopic gastrointestinal surgeries: A randomized controlled trial. Anesth Pain Med. 2013;4:e12750.
    1. Radvansky BM, Shah K, Parikh A, Sifonios AN, Le V, Eloy JD. Role of ketamine in acute postoperative pain management: A narrative review. Biomed Res Int. 2015;2015:749837.
    1. Singh H, Kundra S, Singh RM, Grewal A, Kaul TK, Sood D. Preemptive analgesia with Ketamine for Laparoscopic cholecystectomy. J Anaesthesiol Clin Pharmacol. 2013;29:478–84.
    1. Yang L, Zhang J, Zhang Z, Zhang C, Zhao D, Li J. Preemptive analgesia effects of ketamine in patients undergoing surgery. A meta-analysis. Acta Cir Bras. 2014;29:819–25.
    1. Safavi M, Honarmand A, Nematollahy Z. Pre-incisional analgesia with intravenous or subcutaneous infiltration of ketamine reduces postoperative pain in patients after open cholecystectomy: A randomized, double-blind, placebo-controlled study. Pain Med. 2011;12:1418–26.
    1. Reza FM, Zahra F, Esmaeel F, Hossein A. Preemptive analgesic effect of ketamine in patients undergoing elective cesarean section. Clin J Pain. 2010;26:223–6.
    1. Helmy N, Badawy AA, Hussein M, Reda H. Comparison of the preemptive analgesia of low dose ketamine versus magnesium sulfate on parturient undergoing cesarean section under general anesthesia. Egypt J Anaesth. 2015;31:53–8.

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