Effect of intravenous patient controlled ketamine analgesiaon postoperative pain in opium abusers

Mastane Dahi-Taleghani, Benjamin Fazli, Mahshid Ghasemi, Maryam Vosoughian, Ali Dabbagh, Mastane Dahi-Taleghani, Benjamin Fazli, Mahshid Ghasemi, Maryam Vosoughian, Ali Dabbagh

Abstract

Background: Acutepostoperative pain is among the worst experience that patient scan undergo, and many analgesics have been used to suppress it; especially in chronic opium abusers. Ketamine is an N-methyl-D-aspartate antagonist analgesic, having both anesthetic and analgesic properties, which are not affected to the same extent in chronic opium abusers.

Objectives: In this study, we assessed the analgesic effects of ketamine added to morphine as a patient-controlled analgesia method for acute pain management, compared with a placebo, inchronic maleopium abusers.

Patients and methods: After institutional review board approval for ethical considerations, a randomized double-blinded placebo controlled clinical trial was conducted. A total of 140 male patients aged 18-65 years, undergoing orthopedic surgery, were entered into the study after matching inclusion and exclusion criteria. All patients received the same anesthesia method; while the first group received ketamine (1mg/mL) and morphine (0.5 mg/mL) as a patient-controlled analgesia (70 patients), the second group received morphine (0.5 mg/mL) plus normal saline (70 patients). P value less than 0.05 was considered statistically significant.

Results: The ketamine and morphine group of patients experienced less postoperative pain and required less postoperative rescue analgesia. However, the unwanted postoperative side effects were nearly the same; although increased levels of postoperative nausea and vomiting were observed in the ketamine and morphine group.

Conclusions: This study demonstrated improved analgesic effects after using intravenous patient controlled analgesia with ketamine on postoperative pain in opium abusers.

Keywords: Acute Pain; Drug Users; Ketamine; Opium.

Figures

Figure 1.. Summary of the Study Stages…
Figure 1.. Summary of the Study Stages are Presented in the Diagram

References

    1. American Society of Anesthesiologists Task Force on Acute Pain M. 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(2):248–73. doi: 10.1097/ALN.0b013e31823c1030.
    1. Azarasa M, Azarfarin R, Changizi A, Alizadehasl A. Substance use among Iranian cardiac surgery patients and its effects on short-term outcome. Anesth Analg. 2009;109(5):1553–9. doi: 10.1213/ANE.0b013e3181b76371.
    1. Farrell C, McConaghy P. Perioperative management of patients taking treatment for chronic pain. BMJ. 2012;345:e14129. doi: 10.1136/bmj.e4148.
    1. Khademi H, Malekzadeh R, Pourshams A, Jafari E, Salahi R, Semnani S, et al. Opium use and mortality in Golestan Cohort Study: prospective cohort study of 50,000 adults in Iran. BMJ. 2012;344:e14129. doi: 10.1136/bmj.e2502.
    1. Safari F, Dabbagh A, Sharifnia M. The effect of adjuvant midazolam compared with fentanyl on the duration of spinal anesthesia with 0.5% bupivacaine in opium abusers. Korean J Anesthesiol. 2012;63(6):521–6. doi: 10.4097/kjae.2012.63.6.521.
    1. Dabbagh A, Dahi-Taleghani M, Elyasi H, Vosoughian M, Malek B, Rajaei S, et al. Duration of spinal anesthesia with bupivacaine in chronic opium abusers undergoing lower extremity orthopedic surgery. Arch Iran Med. 2007;10(3):316–20.
    1. Vosoughian M, Dabbagh A, Rajaei S, Maftuh H. The duration of spinal anesthesia with 5% lidocaine in chronic opium abusers compared with nonabusers. Anesth Analg. 2007;105(2):531–3. doi: 10.1213/01.ane.0000268496.46141.4f.
    1. Bell RF, Dahl JB, Moore RA, Kalso E. Perioperative ketamine for acute postoperative pain. Cochrane Database Syst Rev. 2006;(1):CD004603. doi: 10.1002/14651858.CD004603.pub2.
    1. Brown EN, Lydic R, Schiff ND. General anesthesia, sleep, and coma. N Engl J Med. 2010;363(27):2638–50. doi: 10.1056/NEJMra0808281.
    1. Canet J, Castillo J. Ketamine: a familiar drug we trust. Anesthesiology. 2012;116(1):6–8. doi: 10.1097/ALN.0b013e31823da398.
    1. Chazan S, Ekstein MP, Marouani N, Weinbroum AA. Ketamine for acute and subacute pain in opioid-tolerant patients. J Opioid Manag. 2008;4(3):173–80.
    1. Galinski M, Dolveck F, Combes X, Limoges V, Smail N, Pommier V, et al. Management of severe acute pain in emergency settings: ketamine reduces morphine consumption. Am J Emerg Med. 2007;25(4):385–90. doi: 10.1016/j.ajem.2006.11.016.
    1. Gharaei B, Jafari A, Aghamohammadi H, Kamranmanesh M, Poorzamani M, Elyassi H, et al. Opioid-sparing effect of preemptive bolus low-dose ketamine for moderate sedation in opioid abusers undergoing extracorporeal shock wave lithotripsy: a randomized clinical trial. Anesth Analg. 2013;116(1):75–80. doi: 10.1213/ANE.0b013e31826f0622.
    1. Laskowski K, Stirling A, McKay WP, Lim HJ. A systematic review of intravenous ketamine for postoperative analgesia. Can J Anaesth. 2011;58(10):911–23. doi: 10.1007/s12630-011-9560-0.
    1. Loftus RW, Yeager MP, Clark JA, Brown JR, Abdu WA, Sengupta DK, et al. Intraoperative ketamine reduces perioperative opiate consumption in opiate-dependent patients with chronic back pain undergoing back surgery. Anesthesiology. 2010;113(3):639–46. doi: 10.1097/ALN.0b013e3181e90914.
    1. Vadivelu N, Mitra S, Narayan D. Recent advances in postoperative pain management. Yale J Biol Med. 2010;83(1):11–25.
    1. Vosoughin M, Mohammadi S, Dabbagh A. Intravenous ketamine compared with diclofenac suppository in suppressing acute postoperative pain in women undergoing gynecologic laparoscopy. J Anesth. 2012;26(5):732–7. doi: 10.1007/s00540-012-1399-1.
    1. Yeom JH, Chon MS, Jeon WJ, Shim JH. Peri-operative ketamine with the ambulatory elastometric infusion pump as an adjuvant to manage acute postoperative pain after spinal fusion in adults: a prospective randomized trial. Korean J Anesthesiol. 2012;63(1):54–8. doi: 10.4097/kjae.2012.63.1.54.
    1. Elia N, Tramer MR. Ketamine and postoperative pain--a quantitative systematic review of randomised trials. Pain. 2005;113(1-2):61–70. doi: 10.1016/j.pain.2004.09.036.
    1. Joly V, Richebe P, Guignard B, Fletcher D, Maurette P, Sessler DI, et al. Remifentanil-induced postoperative hyperalgesia and its prevention with small-dose ketamine. Anesthesiology. 2005;103(1):147–55.
    1. Subramaniam B, Subramaniam K, Pawar DK, Sennaraj B. Preoperative epidural ketamine in combination with morphine does not have a clinically relevant intra- and postoperative opioid-sparing effect. Anesth Analg. 2001;93(5):1321–6.
    1. Suzuki M. Role of N-methyl-D-aspartate receptor antagonists in postoperative pain management. Curr Opin Anaesthesiol. 2009;22(5):618–22. doi: 10.1097/ACO.0b013e32832e7af6.
    1. Hudcova J, McNicol E, Quah C, Lau J, Carr DB. Patient controlled opioid analgesia versus conventional opioid analgesia for postoperative pain. Cochrane Database Syst Rev. 2006;(4):CD003348. doi: 10.1002/14651858.CD003348.pub2.
    1. Friede T, Kieser M. Sample size recalculation in internal pilot study designs: a review. Biom J. 2006;48(4):537–55.
    1. Karlsson J, Engebretsen L, Dainty K, Isakos Scientific Committee. Considerations on sample size and power calculations in randomized clinical trials. Arthroscopy. 2003;19(9):997–9.
    1. Pandis N, Polychronopoulou A, Eliades T. Sample size estimation: an overview with applications to orthodontic clinical trial designs. Am J Orthod Dentofacial Orthop. 2011;140(4):e141–6. doi: 10.1016/j.ajodo.2011.04.021.
    1. Schafer H, Timmesfeld N, Muller HH. An overview of statistical approaches for adaptive designs and design modifications. Biom J. 2006;48(4):507–20.
    1. Asiabanha M, Asadikaram G, Rahnema A, Mahmoodi M, Hasanshahi G, Hashemi M, et al. Chronic Opium Treatment Can Differentially Induce Brain and Liver Cells Apoptosis in Diabetic and Non-diabetic Male and Female Rats. Korean J Physiol Pharmacol. 2011;15(6):327–32. doi: 10.4196/kjpp.2011.15.6.327.
    1. Besharat S, Jabbari A, Besharat M. Opium as a fatal substance. Indian J Pediatr. 2008;75(11):1125–8. doi: 10.1007/s12098-008-0166-7.
    1. Dabbagh A, Moghadam SF, Rajaei S, Mansouri Z, Manaheji HS. Can repeated exposure to morphine change the spinal analgesic effects of lidocaine in rats? J Res Med Sci. 2011;16(10):1361–5.
    1. Pourshams A, Saadatian-Elahi M, Nouraie M, Malekshah AF, Rakhshani N, Salahi R, et al. Golestan cohort study of oesophageal cancer: feasibility and first results. Br J Cancer. 2005;92(1):176–81. doi: 10.1038/sj.bjc.6602249.
    1. Saadat H, Ziai SA, Ghanemnia M, Namazi MH, Safi M, Vakili H, et al. Opium addiction increases interleukin 1 receptor antagonist (IL-1Ra) in the coronary artery disease patients. PLoS One. 2012;7(9):e14129. doi: 10.1371/journal.pone.0044939.
    1. Jabbary Moghaddam M, Ommi D, Mirkheshti A, Dabbagh A, Memary E, Sadeghi A, et al. Effects of clonidine premedication upon postoperative shivering and recovery time in patients with and without opium addiction after elective leg fracture surgeries. Anesth Pain Med. 2013;2(3):107–10. doi: 10.5812/aapm.7143.
    1. Javid MJ, Hajijafari M, Hajipour A, Makarem J, Khazaeipour Z. Evaluation of a low dose ketamine in post tonsillectomy pain relief: a randomized trial comparing intravenous and subcutaneous ketamine in pediatrics. Anesth Pain Med. 2012;2(2):85–9. doi: 10.5812/aapm.4399.
    1. Dabbagh A. Clonidine: An old friend newly rediscovered. Anesth Pain Med. 2011;1(1):8–9. doi: 10.5812/kowsar.22287523.1802.
    1. Najafi M, Sheikhvatan M. Does analgesic effect of opium hamper the adverse effects of severe coronary artery disease on quality of life in addicted patients? Anesth Pain Med. 2012;2(1):22–7. doi: 10.5812/aapm.5139.
    1. Behdad S, Hajiesmaeili MR, Abbasi HR, Ayatollahi V, Khadiv Z, Sedaghat A. Analgesic Effects of Intravenous Ketamine during Spinal Anesthesia in Pregnant Women Undergone Caesarean Section; A Randomized Clinical Trial. Anesth Pain Med. 2013;3(2):230–3. doi: 10.5812/aapm.7034.
    1. Hosseini Jahromi SA, Hosseini Valami SM, Hatamian S. Comparison between effect of lidocaine, morphine and ketamine spray on post-tonsillectomy pain in children. Anesth Pain Med. 2012;2(1):17–21. doi: 10.5812/aapm.4092.
    1. Khajavi M, Emami A, Etezadi F, Safari S, Sharifi A, Shariat Moharari R. Conscious Sedation and Analgesia in Colonoscopy: Ketamine/Propofol Combination has Superior Patient Satisfaction Versus Fentanyl/Propofol. Anesth Pain Med. 2013;3(1):208–13. doi: 10.5812/aapm.9653.
    1. Bosnjak ZJ, Yan Y, Canfield S, Muravyeva MY, Kikuchi C, Wells CW, et al. Ketamine induces toxicity in human neurons differentiated from embryonic stem cells via mitochondrial apoptosis pathway. Curr Drug Saf. 2012;7(2):106–19.
    1. Brambrink AM, Evers AS, Avidan MS, Farber NB, Smith DJ, Martin LD, et al. Ketamine-induced neuroapoptosis in the fetal and neonatal rhesus macaque brain. Anesthesiology. 2012;116(2):372–84. doi: 10.1097/ALN.0b013e318242b2cd.
    1. Braun S, Gaza N, Werdehausen R, Hermanns H, Bauer I, Durieux ME, et al. Ketamine induces apoptosis via the mitochondrial pathway in human lymphocytes and neuronal cells. Br J Anaesth. 2010;105(3):347–54. doi: 10.1093/bja/aeq169.
    1. Engelhard K, Werner C, Eberspacher E, Bachl M, Blobner M, Hildt E, et al. The effect of the alpha 2-agonist dexmedetomidine and the N-methyl-D-aspartate antagonist S(+)-ketamine on the expression of apoptosis-regulating proteins after incomplete cerebral ischemia and reperfusion in rats. Anesth Analg. 2003;96(2):524–31.
    1. Ponten E, Viberg H, Gordh T, Eriksson P, Fredriksson A. Clonidine abolishes the adverse effects on apoptosis and behaviour after neonatal ketamine exposure in mice. Acta Anaesthesiol Scand. 2012;56(8):1058–65. doi: 10.1111/j.1399-6576.2012.02722.x.
    1. Yagmurdur H, Aksoy M, Arslan M, Baltaci B. The effects of propofol and ketamine on gut mucosal epithelial apoptosis in rats after burn injury. Eur J Anaesthesiol. 2007;24(1):46–52. doi: 10.1017/S0265021506000986.
    1. Zhang X, Paule MG, Newport GD, Sadovova N, Berridge MS, Apana SM, et al. MicroPET imaging of ketamine-induced neuronal apoptosis with radiolabeled DFNSH. J Neural Transm. 2011;118(2):203–11. doi: 10.1007/s00702-010-0499-z.
    1. Bai X, Yan Y, Canfield S, Muravyeva MY, Kikuchi C, Zaja I, et al. Ketamine enhances human neural stem cell proliferation and induces neuronal apoptosis via reactive oxygen species-mediated mitochondrial pathway. Anesth Analg. 2013;116(4):869–80. doi: 10.1213/ANE.0b013e3182860fc9.
    1. Liu JR, Liu Q, Li J, Baek C, Han XH, Athiraman U, et al. Noxious stimulation attenuates ketamine-induced neuroapoptosis in the developing rat brain. Anesthesiology. 2012;117(1):64–71. doi: 10.1097/ALN.0b013e31825ae693.
    1. Persson J. Wherefore ketamine? Curr Opin Anaesthesiol. 2010;23(4):455–60. doi: 10.1097/ACO.0b013e32833b49b3.

Source: PubMed

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