Journal of Isfahan Medical School

Journal of Isfahan Medical School

Comparison the Effect of Intermittent Low Dose Ketamine and Marcaine Infusion through the Sub-pleural Catheter in the Post-Thoracotomy Pain

Document Type : Original Article (s)

Authors
Seyyed Mozafar Hashemi 1
Seyyed Abass Tabatabaie 1
Fatemeh Nili 2
Golshan Taghipour 2
1 Asociate Professor, Deartment of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
2 Medical Student, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Abstract
Background: Lack of adequate relief of pain after thoracotomy can cause many complications. In this study the effect of using low dose ketamine through sub pleural catheter for pain relief after thoracotomy were compared with marcaine.Methods: In this prospective clinical trial study, patients undergoing elective thoracotomy were included. After thoracotomy, for pain relief the patients in case and control groups received 0.5 mg/kg/hr ketamine and 5 cc marcaine 0.5% through sub pleural catheter, respectively. Vital signs, arterial oxygen saturation, and pain level of patients in both groups were recorded and compared at 1 hour after the surgery in recovery and at 8, 16, and 24 hours after surgeryFindings: In ketamine and marcaine groups, 41 and 51 patients were studied, respectively. Mean pain level before intervention and 8, 16, and 24 hours after it was higher in ketamine group (P < 0.05). One hour after local injection of local anesthetic drugs, the level of pain relief was similar in two studied groups (P > 0.05). Systemic analgesic dose used after thoracotomy was significantly lower in marcaine group than ketamine group (P < 0.05). Mean difference of pain before and after injection of local anesthetic drugs in the two groups did not different significantly (P > 0.05).Conclusion: Low-dose ketamine likewise marcaine could be used as a known local anesthetic for post-operative pain relief but this pain reduction is less due to the short half-life of ketamine. 
Keywords
Ketamine
Marcaine
Thoracotomy
Post-operative pain
  1. Takamori S, Yoshida S, Hayashi A, Matsuo T, Mitsuoka M, Shirouzu K. Intraoperative intercostal nerve blockade for postthoracotomy pain. Ann Thorac Surg 2002; 74(2): 338-41.
  2. Kaiser AM, Zollinger A, De Lorenzi D, Largiader F, Weder W. Prospective, randomized comparison of extrapleural versus epidural analgesia for postthoracotomy pain. Ann Thorac Surg 1998; 66(2): 367-72.
  3. Craig DB. Postoperative recovery of pulmonary function. Anesth Analg 1981; 60(1): 46-52.
  4. Spence AA, Smith G. Postoperative analgesia and lung function: a comparison of morphine with extradural block. 1971. Br J Anaesth 1998; 81(6): 984-8.
  5. Mason N, Gondret R, Junca A, Bonnet F. Intrathecal sufentanil and morphine for post-thoracotomy pain relief. Br J Anaesth 2001; 86(2): 236-40.
  6. D'Andrilli A, Ibrahim M, Ciccone AM, Venuta F, De Giacomo T, Massullo D, et al. Intrapleural intercostal nerve block associated with mini-thoracotomy improves pain control after major lung resection. Eur J Cardiothorac Surg 2006; 29(5): 790-4.
  7. Scheinin B, Lindgren L, Rosenberg PH. Treatment of post-thoracotomy pain with intermittent instillations of intrapleural bupivacaine. Acta Anaesthesiol Scand 1989; 33(2): 156-9.
  8. Schmid RL, Sandler AN, Katz J. Use and efficacy of low-dose ketamine in the management of acute postoperative pain: a review of current techniques and outcomes. Pain 1999; 82(2): 111-25.
  9. Clausen L , Sinclair DM , Van Hasselt CH . Intravenous ktamine for postoperative analgesia. S Aft Med J 2002 ; 49 : 1437 -40 .
  10. Klepstad P, Maurset A, Moberg ER, Oye I. Evidence of a role for NMDA receptors in pain perception. Eur J Pharmacol 1990; 187(3): 513-8.
  11. Kohrs R, Durieux ME. Ketamine: teaching an old drug new tricks. Anesth Analg 1998; 87(5): 1186-93.
  12. Maurset A, Skoglund LA, Hustveit O, Oye I. Comparison of ketamine and pethidine in experimental and postoperative pain. Pain 1989; 36(1): 37-41.
  13. Owen H, Reekie RM, Clements JA, Watson R, Nimmo WS. Analgesia from morphine and ketamine. A comparison of infusions of morphine and ketamine for postoperative analgesia. Anaesthesia 1987; 42(10): 1051-6.
  14. Andersen OK, Felsby S, Nicolaisen L, Bjerring P, Jensen TS, Arendt-Nielsen L. The effect of Ketamine on stimulation of primary and secondary hyperalgesic areas induced by capsaicin--a double-blind, placebo-controlled, human experimental study. Pain 1996; 66(1): 51-62.
  15. De Kock M, Lavand'homme P, Waterloos H. 'Balanced analgesia' in the perioperative period: is there a place for ketamine? Pain 2001; 92(3): 373-80.
  16. Ilkjaer S, Dirks J, Brennum J, Wernberg M, Dahl JB. Effect of systemic N-methyl-D-aspartate receptor antagonist (dextromethorphan) on primary and secondary hyperalgesia in humans. Br J Anaesth 1997; 79(5): 600-5.
  17. Martin TJ, Eisenach JC. Pharmacology of opioid and nonopioid analgesics in chronic pain states. J Pharmacol Exp Ther 2001; 299(3): 811-7.
  18. Rabben T, Skjelbred P, Oye I. Prolonged analgesic effect of ketamine, an N-methyl-D-aspartate receptor inhibitor, in patients with chronic pain. J Pharmacol Exp Ther 1999; 289(2): 1060-6.
  19. Adriaenssens G, Vermeyen KM, Hoffmann VL, Mertens E, Adriaensen HF. Postoperative analgesia with i.v. patient-controlled morphine: effect of adding ketamine. Br J Anaesth 1999; 83(3): 393-6.
  20. Tverskoy M, Oz Y, Isakson A, Finger J, Bradley EL, Jr., Kissin I. Preemptive effect of fentanyl and ketamine on postoperative pain and wound hyperalgesia. Anesth Analg 1994; 78(2): 205-9.
  21. Weinbroum AA. A single small dose of postoperative ketamine provides rapid and sustained improvement in morphine analgesia in the presence of morphine-resistant pain. Anesth Analg 2003; 96(3): 789-95, table.
  22. White PF, Way WL, Trevor AJ. Ketamine--its pharmacology and therapeutic uses. Anesthesiology 1982; 56(2): 119-36.
  23. Scheinin B, Lindgren L, Rosenberg PH. Treatment of post-thoracotomy pain with intermittent instillations of intrapleural bupivacaine. Acta Anaesthesiol Scand 1989; 33(2): 156-9.
  24. Schneider RF, Villamena PC, Harvey J, Surick BG, Surick IW, Beattie EJ. Lack of efficacy of intrapleural bupivacaine for postoperative analgesia following thoracotomy. Chest 1993; 103(2): 414-6.
  25. Kambam JR, Hammon J, Parris WC, Lupinetti FM. Intrapleural analgesia for post-thoracotomy pain and blood levels of bupivacaine following intrapleural injection. Can J Anaesth 1989; 36(2): 106-9.
  26. Silomon M, Claus T, Huwer H, Biedler A, Larsen R, Molter G. Interpleural analgesia does not influence postthoracotomy pain. Anesth Analg 2000; 91(1): 44-50.
  27. Gyrov.E,Milanov.S.intrapleural versus epidural analgesia with local anesthetics in patients with thorasic truma .international symphosium on intensive care.245;2004
  28. Shrestha BR, Tabadar S, Maharjan S, Amatya SR. Interpleural catheter technique for perioperative pain management. Kathmandu Univ Med J (KUMJ ) 2003; 1(1): 46-7.
  29. Semsroth M, Plattner O, Horcher E. Effective pain relief with continuous intrapleural bupivacaine after thoracotomy in infants and children. Paediatr Anaesth 1996; 6(4): 303-10.
  30. Tetik O, Islamoglu F, Ayan E, Duran M, Buket S, Cekirdekci A. Intermittent infusion of 0.25% bupivacaine through an intrapleural catheter for post-thoracotomy pain relief. Ann Thorac Surg 2004; 77(1): 284-8.
  31. Dryden CM, McMenemin I, Duthie DJ. Efficacy of continuous intercostal bupivacaine for pain relief after thoracotomy. Br J Anaesth 1993; 70(5): 508-10.
  32. Barbara J,Tempesta C. Prolonged sub pleural infusion of local anesthetic for post thoracotomy pain relief.Chest. 2007; 132-4.
  33. Chung YT, Sun WZ, Huang FY, Cheung YF. Subpleural block in patients with multiple rib fractures. Ma Zui Xue Za Zhi 1990; 28(4): 419-24.
  34. Detterbeck FC. Subpleural catheter placement for pain relief after thoracoscopic resection. Ann Thorac Surg 2006; 81(4): 1522-3.
  35. McKenzie AG, Mathe S. Interpleural local anaesthesia: anatomical basis for mechanism of action. Br J Anaesth 1996; 76(2): 297-9.
  36. Maiwand Mo. Cryoanalgesia for thoracotomy. J thorasic cardio sur 1986; 92: 291-5.
  37. Olivet RT. In search of a more comfortable thoracotomy. Chest 1992; 101(4): 892.
Journal of Isfahan Medical School
Volume 28, Issue 124 - Serial Number 124
November and December 2011
Pages 1978-1988

  • Receive Date 04 April 2011
  • Accept Date 06 April 2022