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Preemptive low-dose epidural ketamine for preventing chronic postthoracotomy pain: a prospective, double-blinded, randomized, clinical trial.

Author(s): Ryu HG, Lee CJ, Kim YT, Bahk JH

Affiliation(s): Department of Anesthesiology and Pain Medicine, Boramae Medical Center, Seoul National University, College of Medicine, 101 Daehang-no, Jongno-gu, Seoul, Korea.

Publication date & source: 2011-05, Clin J Pain., 27(4):304-8.

Publication type: Randomized Controlled Trial

OBJECTIVES: Chronic postthoracotomy pain is the most common long-term complication that occurs after a thoracotomy with a reported incidence of up to 80%. Although thoracic epidural analgesia is a widely used method for managing acute postthoracotomy pain, its effects seems questionable. The objective of this prospective, double-blinded, randomized, controlled trial was to assess the effect of preemptive low-dose epidural ketamine in addition to preemptive thoracic epidural analgesia on the incidence of chronic postthoracotomy pain. METHODS: We analyzed 133 patients who were randomized to preemptive thoracic epidural analgesia either with or without ketamine (Group K: 0.12% levobupivacaine, 2 mug/mL of fentanyl, 0.2 mg/mL ketamine, total volume of 500 mL vs. Group KF: 0.12% levobupivacaine, 2 mug/mL of fentanyl, total volume of 500 mL). Pain at the thoracotomy scar site during rest and movement (coughing) was assessed at 2 weeks and 3 months after surgery using a visual analog scale. The incidence of allodynia and numbness was also evaluated. RESULTS: There was no difference in the incidence of chronic postthoracotomy pain at 3 months between the 2 groups (67.7% in group K vs. 75% in group KF). The incidences of allodynia or numbness were not different between the 2 groups. DISCUSSION: The addition of preemptive low-dose epidural ketamine (1.2 mg/h) to preemptive thoracic epidural analgesia did not have any beneficial effects in preventing chronic postthoracotomy pain.

Page last updated: 2011-12-09

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