Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2020 Feb 26;56(3):96.
doi: 10.3390/medicina56030096.

Role of Ketamine in Multimodal Analgesia Protocol for Bariatric Surgery

Greta Kasputytė  1 , Aurika Karbonskienė  1 , Andrius Macas  1 , Almantas Maleckas  2
Affiliations
Randomized Controlled Trial

Role of Ketamine in Multimodal Analgesia Protocol for Bariatric Surgery

Greta Kasputytė et al. Medicina (Kaunas). .

Abstract

Background and Objectives: Acute postoperative pain is one of the most undesirable experiences for a patient in the postoperative period. Many options are available for the treatment of postoperative pain. One of the methods of multimodal analgesia is a combination of opioids and adjuvant agents, such as ketamine. The aim of this study was to evaluate the effect of a pre-incisional single injection of low-dose ketamine on postoperative pain after remifentanil infusion in patients undergoing laparoscopic gastric bypass or gastric plication surgery. Materials and Methods: The prospective, randomized, double-blinded and placebo-controlled trial took place at the Hospital of the Lithuanian University of Health sciences KaunoKlinikos in 2015-2017. A total of 32 bariatric patients (9 men and 23 women) were randomly assigned to receive a single pre-incisional injection of ketamine (0.15 mg/kg (LBM)) (ketamine, K group) or saline (placebo, S group). Standardized protocol of anesthesia and postoperative pain management was followed for all patients. Postoperative pain intensity, postoperative morphine requirements, incidence of side effects and patients' satisfaction with postoperative analgesia were recorded. Results: Thirty-two patients undergoing bariatric surgery: 18 (56.25%; gastric bypass) and 14 (43.75%; gastric plication) were examined. Both groups did not differ in demographic values, duration of surgery and anesthesia and intraoperative drug consumption. Postoperative pain scores were similar in both groups (p = 0.105-0.941). Morphine consumption was 10.0 (7.0-12.5 mg) in group S and 9.0 (3.0-15.0 mg) in group K (p = 0.022). The incidence of side effects was similar in both groups (p = 0.412). Both groups demonstrated very high satisfaction with postoperative analgesia. Conclusions: Pre-incisional single dose ketamine reduces postoperative opioids consumption, but does not have an effect of postoperative pain intensity and side effects after remifentanil infusions. Very high patient satisfaction is achieved if standard multimodal analgesia protocol with an individual assessment of pain and dosage of medications is followed.

Keywords: bariatric surgery; ketamine; postoperative pain; remifentanil.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flow chart for patient enrollment. * Patients who have undergone previous abdominal surgical procedures.
Figure 2
Figure 2
Analysis of the relation of total morphine amount used in the post-anesthetic care unit and patient postoperative pain in the numeric pain rating scale (NPRS) score.
Figure 3
Figure 3
Postoperative pain intensity in PACU.
Figure 4
Figure 4
The incidence of side effects after surgery in PACU: S—saline group, K—ketamine group.
Figure 5
Figure 5
Patient satisfaction with pain treatment in the next day after surgery: S—saline group, K—ketamine group.
See this image and copyright information in PMC

References

    1. Apfelbaum J.L., Chen C., Mehta S.S., Gan T.J. Postoperative pain experience: Results from a national survey suggest postoperative pain continues to be undermanaged. Anesth. Analg. 2003;97:534–540. doi: 10.1213/01.ANE.0000068822.10113.9E. - DOI - PubMed
    1. Pundzius J.C. II Tomas. Specialioji dalis. Vitae Litera; Kaunas, Lithuania: 2012. pp. 962–977.
    1. Gritsenko K., Khelemsky Y., Kaye A.D., Vadivelu N., Urman R.D. Multimodal therapy in perioperative analgesia. Best Pract. Res. Clin. Anaesthesiol. 2014;28:59–79. doi: 10.1016/j.bpa.2014.03.001. - DOI - PubMed
    1. Chou R., Gordon D.B., de Leon-Casasola O.A., Rosenberg J.M., Bickler S., Brennan T., Carter T., Cassidy C.L., Chittenden E.H., Degenhardt E., et al. Management of postoperative pain: A clinical practice guideline from American pain society, the American society of regional anesthesia and Pain medicine, and the American society of anesthesiologists’ committee on regional anesthesia, Executice committee, and Administrative council. J. Pain. 2016;17:131–157. - PubMed
    1. Hasanein R., El-Sayed W., Nabil N., Elsayed G. The effect of combined remifentanil and low dose ketamine infusion in patients undergoing laparoscopic gastric bypass. Egypt. J. Anaesth. 2011;27:255–260. doi: 10.1016/j.egja.2011.07.009. - DOI

Publication types

MeSH terms