Analgesic effects of ketamine infusion on postoperative pain after fusion and
instrumentation of the lumbar spine: a prospective randomized clinical trial.
Author(s): Abrishamkar S, Eshraghi N, Feizi A, Talakoub R, Rafiei A, Rahmani P.
Affiliation(s): Department of Neurosurgery, School of Medicine, Isfahan University of Medical
Sciences, Isfahan, Iran.
Publication date & source: 2012, Med Arh. , 66(2):107-10
BACKGROUND: Intractable pain occurs as a result of extensive damage to soft
tissue, bones and muscles after fusion of lumbar spondylolisthesis. Although
different drugs and protocols have been suggested for postoperative pain
management, the best method of treatment has not been proposed yet. Therefore,
this study tried to compare the efficacy of ketamine infusion and routine opioid
administration on postoperative pain.
METHODS: A double-blind prospective randomized clinical trial was performed on 45
patients candidate for fusion of lumbar spondylolisthesis. Patients were divided
into two groups of A (treatment) and B (control). In group A, pain was controlled
by intravenous infusion of ketamine. Morphine was also administrated when the
patients scored their pain above 4 on a visual analogue scale (VAS). In group B,
intravenous infusions of morphine were performed every 6 hours. VAS and whole
dosage of morphine were compared between two groups every 6 hours.
RESULTS: Morphine and ketamine were both effective on pain control. Mean values
of pain intensity at the first to fourth time points were 2.1, 1.8, 1.6, and 1.7
in group A and 3.9, 3.4, 3.5, and 3.5 in group B, respectively (p < 0.01 for all
periods). However, ketamine was more efficient in pain reduction during the first
24 hours (p < 0.001).
CONCLUSION: Ketamine could be a good alternative analgesic after fusion of lumbar
spondylolisthesis. However, the probable side effects should also be considered.
Ketamine infusion is more effective than morphine on postoperative pain control.
In addition, tolerance to drug application is not a challenging problem at least
during 24 hours after operation.
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