Key result
Adding a low-dose ketamine infusion to remifentanil during scoliosis surgery reduced 24-hour postoperative morphine consumption and improved intraoperative haemodynamic stability compared to remifentanil alone.
Why the study?
Does adding low dose ketamine to remifentanil improve intraoperative haemodynamic stability and postoperative pain control in patients undergoing scoliosis surgery?
RCT (n=40)
Double-blind
randomized
No
Does adding low dose ketamine to remifentanil improve intraoperative haemodynamic stability and postoperative pain control in patients undergoing scoliosis surgery?
Adding low-dose ketamine to remifentanil during scoliosis surgery improves postoperative pain control and reduces morphine consumption.
Answers are grounded in this paper and cite their sources.
Supports adding low-dose ketamine to remifentanil in scoliosis surgery to cut opioid needs; extends multimodal analgesia evidence in major spine procedures.
Aim: The aim of this study was to conduct a pharmaceutical care programme for two different anaesthetic methods used during scoliosis surgery, to investigate which method ensured better intraoperative haemodynamic stability and postoperative pain control.Methods: A clinical pharmacist actively participated in a prospective randomised double blind study for 40 patients who had a physical status class I-II ASA, scheduled for scoliosis surgery, who were randomly allocated into two groups, 20 in each group. Both groups received midazolam preoperatively, propofol, sevuflorane, atracurium, and either remifentanil infusion 0.2 μg/kg/min for (Group 1 = G1), or the same dose of remifentanil infusion and low dose ketamine infusion 1 μg/kg/min (Group 2 = G2), antidote medications and postoperative morphine. Patients were subject to a pharmaceutical care programme. Heart rate HR, MAP, vital signs, surgical bleeding, urine output, time to accomplish the wake up test, duration of surgery and duration of anesthesia were recorded. In postanesthesia care unit (PACU) for 24 hours, the recovery time, the first pain score and analgesic requirements were assessed. All drugs used were documented in medical charts for statistical analysis.Results: Intraoperative heart rate and arterial blood pressure were significantly less (p < 0.05) in G1 as compared with G2. In the (PACU) the first pain score recordings were significantly less (p < 0.05) in G2 than G1. The time which passed until the first patient analgesia demand dose was greater in G2 and morphine consumption was greater in G1 than G2 (p < 0.05). The rest of the results were not significantly different between the two groups. None of the patients had any allergic or adverse drug reaction to any of the medications.Conclusions: Adding a low dose ketamine hydrochloride infusion during scoliosis surgery could be applied as a routine therapy to improve the haemodynamic stability during the surgery and reduce the postoperative morphine consumption. A pharmaceutical care programme tested in this study gave a high score for patient satisfaction.
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Hadi et al. (2009) conducted an RCT in Scoliosis (n=40). Ketamine and remifentanil infusion vs. Remifentanil 0.2 μg/kg/min alone was evaluated on Total 24-hour postoperative morphine consumption (mg) (p=<0.05). Adding a low-dose ketamine infusion to remifentanil during scoliosis surgery reduced 24-hour postoperative morphine consumption and improved intraoperative haemodynamic stability compared to remifentanil alone.
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