REVISTA

Evaluación del efecto de la ketamina en la hiperalgesia inducida por remifentanilo: un estudio aleatorio doble ciego

Descripción: En la evaluación del efecto de la ketamina en la hiperalgesia inducida por remifentanilo no se encontró ninguna diferencia entre los grupos controles durante las siguientes 24h a la dosis preestablecida

TITULO FUENTE ORIGINAL:

Evaluation of the effect of ketamine on remifentanil-induced hyperalgesia: a double-blind, randomized study

AUTORES:

Leal PC, Salomão R, Brunialti MK, Sakata RK

REVISTA ABREV.:

Journal of Clinical Anesthesia

AÑO:

2015

REFERENCIA:

27(4):331-7

DOI:

10.1016/j.jclinane.2015.02.002

RESUMEN ORIGINAL:

STUDY OBJECTIVE:
Opioids are associated with hyperalgesia that can reduce their analgesic effect. The aim of this study was to determine whether the addition of ketamine reduces remifentanil-induced hyperalgesia; improves its analgesic effect; and alters interleukin 6 (IL-6), IL-8, and IL-10 levels.
DESIGN:
This is a prospective, randomized, double-blind...
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STUDY OBJECTIVE:
Opioids are associated with hyperalgesia that can reduce their analgesic effect. The aim of this study was to determine whether the addition of ketamine reduces remifentanil-induced hyperalgesia; improves its analgesic effect; and alters interleukin 6 (IL-6), IL-8, and IL-10 levels.

DESIGN:
This is a prospective, randomized, double-blind study.

SETTING:
The setting is in a operating room and ward in a university hospital.

PATIENTS:
There are 56 patients, aged ≥18 years, American Society of Anesthesiologists I or II, who underwent laparoscopic cholecystectomy.

INTERVENTIONS:
Anesthesia was induced with remifentanil, 50% oxygen, and isoflurane. Patients randomized to group 1 received remifentanil (0.4 μg/kg per minute) and ketamine (5 μg/kg per minute), and patients randomized to group 2 received remifentanil (0.4 μg/kg per minute) and saline solution. Postoperative analgesia was achieved using morphine via patient-controlled analgesia.

MEASUREMENTS:
The measurements were postoperative pain intensity during 24 hours; morphine consumption; time to first morphine supplementation; hyperalgesia (using monofilaments and an algometer) and allodynia (using a soft brush) in the thenar eminence of the nondominant hand and in the periumbilical region 24 hours after surgery; extent of hyperalgesia using a 300-g monofilament near the periumbilical region 24 hours after surgery; and serum levels of IL-6, IL-8, and IL-10.

MAIN RESULTS:
Groups were similar for baseline characteristics. There were no differences in pain intensity, time to first request of morphine, and total 24 hours dose of morphine between groups. There was a difference in hyperalgesia using monofilaments 24 hours after the surgery in the thenar eminence of the nondominant hand, with a better profile for the experimental group. However, there were no differences in hyperalgesia using an algometer, in allodynia using a soft brush; in extent of hyperalgesia; or in levels of IL-6, IL-8, and IL-10.

CONCLUSIONS:
It was not possible to demonstrate that the addition of ketamine (5 μg/kg per minute) is effective in preventing or reducing remifentanil-induced postoperative hyperalgesia in laparoscopic cholecystectomy

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