Ketamine Versus Tramadol as an Adjunct to PCA Morphine for Postoperative Analgesia after Major Upper Abdominal Surgery: A Prospective, Comparative, Randomized Trial
Article Category: Research Article
Data publikacji: 10 sie 2020
Zakres stron: 43 - 51
DOI: https://doi.org/10.2478/rjaic-2020-0005
Słowa kluczowe
© 2020 Paraskevi K. Matsota et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
Background and aims
Patient-controlled analgesia (PCA) with morphine is commonly used to provide analgesia following major surgery, but is not sufficient as a monotherapy strategy. This study aimed to compare the adjunctive analgesic effect of ketamine versus tramadol on postoperative analgesia provided via PCA-morphine in patients undergoing major upper abdominal surgeries.
Methods
Forty-two patients undergoing elective major upper abdominal surgery under general anesthesia were allocated to receive either ketamine (load dose of 0.5 mg kg−1 followed by a continuous infusion of 0.12 mg kg−1 h−1 up to 48 postoperative hours; ketamine group, n = 21) or tramadol (load dose of 1 mg kg−1 followed by a continuous infusion of 0.2 mg kg−1 h−1 up to 48 postoperative hours; tramadol group, n = 21) in addition to their standard postoperative analgesia with PCA-morphine. Postoperative data included morphine consumption, visual analog scale (VAS) scores, and side effects during the first 48 postoperative hours after PCA-morphine initiation.
Results
There were no significant differences in patient demographic and intraoperative data between the two groups. Tramadol group had significantly less total morphine consumption during the first 48 postoperative hours (28.905 [16.504] vs 54.524 [20.846] mg [p < 0.001]) and presented significantly lower VAS scores at rest and mobilization (p < 0.05) than the ketamine group. No statistical difference was recorded between the two groups (p > 0.05) regarding postoperative cough, sedation, hallucinations, pruritus, urine retention, and postoperative nausea and vomiting. However, patients in the ketamine group reported dry mouth more frequently than patients in the tramadol group (p = 0.032).
Conclusions
Postoperative administration of tramadol was superior to ketamine due to significantly reduced opioid consumption and better pain scores in patients receiving PCA-morphine after major upper abdominal surgery.