A randomized, double blind, placebo controlled clinical trial of the preoperative
use of ketamine for reducing inflammation and pain after thoracic surgery.
Author(s): D'Alonzo RC, Bennett-Guerrero E, Podgoreanu M, D'Amico TA, Harpole DH, Shaw AD.
Affiliation(s): Department of Anesthesiology, Pitt Count Memorial Hospital, Greenville, NC 27858,
USA.
Publication date & source: 2011, J Anesth. , 25(5):672-8
PURPOSE: We hypothesized that patients who received ketamine during thoracic
surgery would benefit from suppression of the inflammatory cascade, represented
by lower interleukin (IL)-6 and C-reactive protein (CRP) plasma levels.
METHODS: This study was a randomized, double blind, placebo controlled clinical
trial of ketamine in patients undergoing thoracic surgery. The setting was a
single university teaching hospital. Forty patients who presented to the
preoperative clinic prior to thoracic surgery (20 control, 20 treatment) were
randomized to receive either a 0.5 mg/kg ketamine bolus or an equivalent volume
of normal saline intravenously prior to chest wall incision. Plasma samples taken
prior to induction of anesthesia and at 24 h following surgery were assayed for
IL-6 and CRP levels. Verbal pain scores were reported at 4 and 24 h following
surgery and at discharge.
RESULTS: IL-6 plasma levels did not differ significantly at 24 h for patients
receiving ketamine (245 ± 287 pg/ml, mean ± SD) compared to patients who received
placebo (269 ± 210 pg/ml), p = 0.39. Additionally, CRP levels at 24 h were not
significantly different (8.8 ± 4.5 mg/dl for ketamine, 9.3 ± 5.6 mg/dl for
placebo patients), p = 0.37. Finally, verbal pain scores were not significantly
different between patient groups at 4 or 24 h, or at discharge.
CONCLUSIONS: These findings suggest that the routine use of a single dose of
ketamine prior to chest wall incision is not effective at reducing pain or
inflammation in thoracic surgery patients at 24 h postoperatively.
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