Beneficial effects of adding ketamine to intravenous patient-controlled analgesia with fentanyl after the Nuss procedure in pediatric patients.

PURPOSE: The aim of this prospective, double-blind, randomized study was to investigate the analgesic effects of low-dose ketamine on intravenous patient-controlled analgesia (IV-PCA) with fentanyl for pain control in pediatric patients following the Nuss procedure for pectus excavatum. MATERIALS AND METHODS: Sixty pediatric patients undergoing the Nuss procedure were randomly assigned to receive fentanyl (Group F, n=30) or fentanyl plus ketamine (Group FK, n=30). Ten minutes before the end of surgery, following the loading dose of each solution, 0.5 µg/kg/hr of fentanyl or 0.5 µg/kg/hr of fentanyl plus 0.15 mg/kg/hr of ketamine was infused via an IV-PCA pump (basal rate, 1 mL/hr; bolus, 0.5 mL; lock out interval, 30 min). Fentanyl consumption, pain score, ketorolac use, nausea/vomiting, ondansetron use, pruritus, respiratory depression, hallucination, dreaming, and parent satisfaction with pain control were measured throughout the 48 hours following surgery. RESULTS: The pain scores, ketorolac use, and fentanyl consumption of Group FK were significantly lower than in Group F (p<0.05). The incidence of nausea/vomiting and ondansetron use in Group FK was significantly lower than in Group F (p<0.05). There were no reports of respiratory depression, hallucination or dreaming. Parent satisfaction with pain control was similar between the two groups. CONCLUSION: We concluded that low-dose ketamine added to IV-PCA with fentanyl after the Nuss procedure in pediatric patients can reduce pain scores, consumption of fentanyl, and incidence of nausea/vomiting without increasing side effects.

Effect of fentanyl on hemodynamic changes connected with a thigh tourniquet during knee arthroscopic surgery.

BACKGROUND: The use of a tourniquet can produce pain and increase in blood pressure. It is known that fentanyl reduces central sensitization, however its effect on blood pressure increase due to tourniquet is unknown. So we investigated the effect of fentanyl on tourniquet-induced changes of mean arterial blood pressure (MBP), heart rate (HR), and cardiac index (CI). METHODS: ASA physical status I and II, who were scheduled for knee arthroscopic surgery using a tourniquet, were assigned into control (n = 30) and fentanyl group (n = 30). Anesthesia was maintained with enflurane, N2O and O2. Fentanyl was injected 1.5 ug/kg at 10 min before inflation of the tourniquet in the fentanyl group. Changes of the MBP, HR, CI were measured before and 10, 20, 30, 40, 50, 60 min after inflation of the tourniquet. RESULTS: There were no differences in the baseline values. MBP was increased at 40, 50, 60 min in the control group. At 60 min, MBP was lower in the fentanyl than the control group. HR was decreased at 10 min in the fentanyl group. CI was decreased in all groups after tourniquet inflation. At 60 min, CI was more decreased in the control than the fentanyl group. CONCLUSIONS: Fentanyl injection prior to tourniquet inflation can attenuate the tourniquet induced hemodynamic changes in the knee arthroscopic surgery patients.