Comparative Controlled Study of Preventive Effect of Combinations of Ketamine and Metoclopramide vs Ketamine and Paracetamol on Postoperative Pain

Document Type : Original Article (s)

Authors

1 Professor, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Student of Medicine, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: In this study, we compared the effects combinations of ketamine and paracetamol with ketamine and metoclopramide on postoperative pain and their effects on surgical complications. Then, better method for reducing pain and complications was referenced.Methods: In a clinical trial study, 102 candidates for laparoscopic surgery under general anesthesia divided into three equal groups of ketamine and metoclopramide, ketamine and paracetamol, and control. In the first group, 0.5 mg/kg ketamine and 0.1 mg/kg metoclopramide, in the second group, 0.5 mg/kg ketamine and 1 g paracetamol, and in the third group, normal saline were injected. Patients’ systolic and diastolic blood pressures and heart rates in all three groups were measured and recorded every 15 minutes. Then, the effects of these two drug combinations on postoperative pain and some other complications were studied and compared between the three groups.Findings: Average pain intensity was significantly different among the three treated groups (P < 0.05 for all). 2 and 6 hours after the surgery, pain in the group receiving ketamine and paracetamol was significantly lower than the other two groups (P < 0.05). 12 and 24 hours after the surgery, pain was significantly lower than control group just in the group receiving ketamine and paracetamol (P < 0.05).Conclusion: Combination of ketamine and paracetamol is more favorable because of significant decrease in postoperative pain.

Keywords

References

  1. Yalcin N, Uzun ST, Reisli R, Borazan H, Otelcioglu S. A comparison of ketamine and paracetamol for preventing remifentanil induced hyperalgesia in patients undergoing total abdominal hysterectomy. Int J Med Sci 2012; 9(5): 327-33.
  2. Heidari-Tabaee-Zavareh SM, Saryazdi H, Salehi J. Comparing the effect of metoclopramide and ketamine as a preemptive analgesia on postoperative pain. J Shahrekord Univ Med Sci 2011; 13(2): 38-45. [In Persian].
  3. Heidari SM, Rahimi M, Saeb F, Shafa A. Comparison of the effect of intravenous midazolam, metoclopramide and their combination on the treatment of postoperative nausea and vomiting: A double blinded randomized clinical trial. Pak J Med Sci 2011; 27(4): 847-50.
  4. Gousheh SM, Nesioonpour S, Javaher FF, Akhondzadeh R, Sahafi SA, Alizadeh Z. Intravenous paracetamol for postoperative analgesia in laparoscopic cholecystectomy. Anesth Pain Med 2013; 3(1): 214-8.
  5. Jabalameli M, Goudarzi L. Preventive effects of intravenous paracetamol in post-partum pain of elective cesarean delivery with spinal anesthesia. J Isfahan Med Sch 2014; 32(296): 1227-37. [In Persian].
  6. Werunga KP, Khainga SO, Musau P, Emarah M, Lumarai L. Use of combined paracetamol and low dose ketamine in pain control during change of dressings in burn patients. East Afr Med J 2011; 88(3): 101-3.
  7. Heidari SM, Khalili Gh, Roohani S, Mehrabi Koushki A. Comparing the effects of ketamine alone and in combination with metoclopramide on postoperative pain. J Isfahan Med Sch 2013; 30(221): 2441-9. [In Persian].
  8. Hyllested M, Jones S, Pedersen JL, Kehlet H. Comparative effect of paracetamol, NSAIDs or their combination in postoperative pain management: A qualitative review. Br J Anaesth 2002; 88(2): 199-214.
  9. Ong CK, Seymour RA, Lirk P, Merry AF. Combining paracetamol (acetaminophen) with nonsteroidal antiinflammatory drugs: A qualitative systematic review of analgesic efficacy for acute postoperative pain. Anesth Analg 2010; 110(4): 1170-9.
  10. Hong JY, Kim WO, Chung WY, Yun JS, Kil HK. Paracetamol reduces postoperative pain and rescue analgesic demand after robot-assisted endoscopic thyroidectomy by the transaxillary approach. World J Surg 2010; 34(3): 521-6.
  11. Heidari SM, Qanavi M, Raeesi L. Comparing the preventive effect of combination of ketamine with metoclopramide or fentanyl on the postoperative pain after laparoscopic cholecystectomy under general anesthesia. J Isfahan Med Sch 2015; 33(347): 1357-69. [In Persian].
  12. Norouzi A, Haji-beigi L, Abbasi Talarposhti M, Mashhadi E, Jamilian M. The effect of adding intravenous Metoclopramide to Pethidine for postoperative cesarean section pain. J Arak Univ Med Sci 2006; 9(4): 93-9. [In Persian].
  13. Lyons PJ, Rivosecchi RM, Nery JP, Kane-Gill SL. Fentanyl-Induced Hyperalgesia in Acute Pain Management. J Pain Palliat Care 2015; 29(2): 153-60.
  14. Amrimaleh P, Alijanpour E, Zabihi A, Attarzadeh H, Shirkhani Z, Rezaee B, et al. Comparison of analgesic effect of intravenous paracetamol plus meperidine and meperedine alone on postoperative pain after elective cesarean. J Anesth Pain 2013; 4(1): 1-7. [In Persian].
  15. Heidari SM, Ahmadi M, Mehrabi-Koushki A. Comparing the effect of preemptive intravenous acetaminophen and ketamine on postoperative pain. J Isfahan Med Sch 2015; 33(328): 368-77. [In Persian].
  16. Alimian M, Pournajafian A, Kholdebarin A, Ghodraty M, Rokhtabnak F, Yazdkhasti P. Analgesic effects of paracetamol and morphine after elective laparotomy surgeries. Anesth Pain Med 2014; 4(2): e12912.
  17. Montgomery JE, Sutherland CJ, Kestin IG, Sneyd JR. Morphine consumption in patients receiving rectal paracetamol and diclofenac alone and in combination. Br J Anaesth 1996; 77(4): 445-7.
  18. Heidari SM, Saryazdi H, Shafa A, Arefpour R. Comparison of the effect of preoperative administration of Ringer's solution, normal saline and hypertonic saline 5% on postoperative nausea and vomiting: A randomized, double blinded clinical study. Pak J Med Sci 2011; 27(4): 771-4.
  19. Guillou N, Tanguy M, Seguin P, Branger B, Campion JP, Malledant Y. The effects of small-dose ketamine on morphine consumption in surgical intensive care unit patients after major abdominal surgery. Anesth Analg 2003; 97(3): 843-7.
Journal of Isfahan Medical School
Volume 35, Issue 456 - Serial Number 456
September and October 2018
Pages 1683-1689

Files

History

  • Receive Date: 19 June 2017
  • Revise Date: 13 May 2024
  • Accept Date: 06 April 2022

Share

How to cite

Statistics