Preemptive Effect of Preoperative Intravenous Ketamine / 대한마취과학회지

ABSTRACT

BACKGROUND: Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist with analgesic properties that may be important in the modulation of central sensitization to nociceptive stimulation. The aim of the present study was to determine if preemptive administration of systemic ketamine decreases postoperative pain when compared with postwound closure administration of ketamine. METHODS: Forty-five patients scheduled for total abdominal hysterectomy were divided into three groups. Before surgical incision, 0.5 mg/kg ketamine was administered alone (group 1, n=15) or followed by ketamine infusion of 10 microgram/kg/min until abdominal closure (group 2, n=15). The other patients were given 0.5 mg/kg of ketamine immediately after abdominal closure (group 3, n=15). Patient-controlled analgesia (PCA) using butorphanol and ketorolac was started after the awakening of patients. Postoperative pain and total infusion doses of the PCA drug were assessed during the 48 hr. period after awakening. RESULTS: The total infusion dose of the PCA drug was significantly lower in group 1 and 2. No significant intergroup differences were seen in the pain score, sedation score and incidences of side effects. CONCLUSIONS: Preoperative and intraoperative administration of ketamine is more effective in reducing postoperative analgesic requirements than it is when given after operation.