J Korean Med Sci.  2014 Jul;29(7):1001-1006. 10.3346/jkms.2014.29.7.1001.

Does Intravenous Ketamine Enhance Analgesia after Arthroscopic Shoulder Surgery with Ultrasound Guided Single-Injection Interscalene Block?: A Randomized, Prospective, Double-Blind Trial

• Woo JH
• Kim YJ
• Baik HJ
• Han JI
• Chung RK

• KMID: 1789962
• DOI: http://doi.org/10.3346/jkms.2014.29.7.1001

Abstract

Ketamine has anti-inflammatory, analgesic and antihyperalgesic effect and prevents pain associated with wind-up. We investigated whether low doses of ketamine infusion during general anesthesia combined with single-shot interscalene nerve block (SSISB) would potentiate analgesic effect of SSISB. Forty adult patients scheduled for elective arthroscopic shoulder surgery were enrolled and randomized to either the control group or the ketamine group. All patients underwent SSISB and followed by general anesthesia. During an operation, intravenous ketamine was infused to the patients of ketamine group continuously. In control group, patients received normal saline in volumes equivalent to ketamine infusions. Pain score by numeric rating scale was similar between groups at 1, 6, 12, 24, 36, and 48 hr following surgery, which was maintained lower than 3 in both groups. The time to first analgesic request after admission on post-anesthesia care unit was also not significantly different between groups. Intraoperative low dose ketamine did not decrease acute postoperative pain after arthroscopic shoulder surgery with a preincisional ultrasound guided SSISB. The preventive analgesic effect of ketamine could be mitigated by SSISB, which remains one of the most effective methods of pain relief after arthroscopic shoulder surgery.

Keyword

Ketamine; Interscalene Nerve Block; Shoulder Surgery; Pain, Postoperative

MeSH Terms

Adult
Aged
Analgesia, Patient-Controlled
Analgesics/*administration & dosage
Arthroscopy
Brachial Plexus/ultrasonography
Double-Blind Method
Female
Humans
Injections, Intravenous
Ketamine/*administration & dosage
Male
Middle Aged
Nerve Block
Pain Measurement
Pain, Postoperative/*drug therapy
Prospective Studies
Shoulder/*surgery
Time Factors
Analgesics
Ketamine

Figure

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  Fig. 1 Numeric rating scale of pain during postoperative 48 hr. There was no significant difference between groups. Group N, the control group; Group K, the ketamine group. Numeric rating scale; 0, no pain; 10, worst pain imaginable.

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  Fig. 2 The cumulative number of PCA attempts (A) and total consumption of PCA medication (B) for postoperative 48 hr. There was no significant difference between groups. Group N, the control group; Group K, the ketamine group; PCA, patient-controlled analgesia.

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