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Lack of a pre-emptive effect of low-dose ketamine on postoperative pain following oral surgery

[Absence d’effet préventif de faibles doses de kétamine sur la douleur postopératoire en chirurgie buccale]

Thierry Lebrun, MD^*, Alain C. Van Elstraete, MD^*, Ignace Sandefo, MD^*, Bruno Polin, MD^* and Luc Pierre-Louis, MD

^* From the Departments of Anesthesiology, and
Stomatology, Clinique Saint-Paul, Clairière, Fort de France, Martinique, French West Indies.

Address correspondence to: Dr. Alain Van Elstraete, Department of Anesthesiology, Clinique Saint-Paul, Clairière, 97200 Fort de France, Martinique, FWI. Phone: +596-394076; Fax: +596-705647; E-mail: alainvanel{at}hotmail.com

Purpose: The aim of this study was to assess the effect of pre- vs postincisional low-dose iv ketamine on postoperative pain in outpatients scheduled for oral surgery under general anesthesia.

Methods: Eighty-four patients were randomly assigned to receive intravenously saline before and after surgery in Group 1, ketamine 300 µg·kg^–1 iv before and saline after surgery in Group 2, saline before and ketamine 300 µg·kg^–1 iv after surgery in Group 3. Postoperative analgesia consisted of iv proparacetamol and ketoprofen. Rescue analgesia consisted of nalbuphine 200 µg·kg^–1 iv. Analgesia at home consisted of oral ketoprofen, and acetaminophen with codeine as rescue analgesia. A telephone interview was conducted on the first and second postoperative days.

Results: There were no significant differences between groups with respect to pain scores, the number of patients requiring nalbuphine in the postanesthesia care unit (PACU), (36.7%, 38.7%, and 39.5% for Groups 1, 2, and 3 respectively), or nalbuphine consumption in the PACU (66.5 µg·kg^–1 ± 16.8, 75.9 µg·kg^–1 ± 17.5, 66.7 µg·kg^–1 ± 21.6 for Groups 1, 2, and 3 respectively). The number of rescue analgesic tablets taken at home, and time to first request for rescue analgesia, sedation scores, or side-effects were similar amongst groups. No patient required nalbuphine in the ambulatory care unit.

Conclusions: There was no benefit to pre-emptive administration of ketamine 300 µg·kg^–1 iv whether administered pre- or postoperatively.

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