Effect of Intrathecally Administered Ketamine, Morphine, and Their Combination Added to Bupivacaine in Patients Undergoing Major Abdominal Cancer Surgery a Randomized, Double-Blind Study

• Published in: Pain medicine (Malden, Mass.) Vol. 19; no. 3; pp. 561 - 568
• Main Authors: Abd El-Rahman, Ahmad M, Mohamed, Ashraf A, Mohamed, Sahar A, Mostafa, Mohamed A M
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.03.2018
• Subjects: Abdomen; Abdominal Neoplasms - surgery; Adult; Analgesia; Analgesia - methods; Analgesics - administration & dosage; Anesthesia; Bupivacaine; Bupivacaine - administration & dosage; Cancer; Cancer surgery; Clinical trials; Digestive System Surgical Procedures - adverse effects; Double-Blind Method; Double-blind studies; Female; Gastric cancer; Gastrointestinal surgery; Humans; Injections, Spinal; Ketamine; Ketamine - administration & dosage; Male; Middle Aged; Morbidity; Morphine; Morphine - administration & dosage; Pain management; Pain perception; Pain, Postoperative - prevention & control; Postoperative period; Side effects; Surgery; Morphine; Ketamine; Lower Abdominal Cancer Surgery; Intrathecal
• ISSN: 1526-2375; 1526-4637
• DOI: 10.1093/pm/pnx105

Abstract Objective Effective postoperative pain control reduces postoperative morbidity. In this study, we investigated the effects of intrathecal morphine, ketamine, and their combination with bupivacaine for postoperative analgesia in major abdominal cancer surgery. Study Design Prospective, randomized, double-blind. Setting Academic medical center. Patients and Methods Ninety ASA I–III patients age 30 to 50 years were divided randomly into three groups: the morphine group (group M) received 10 mg of hyperbaric bupivacaine 0.5% in 2 mL volume and 0.3 mg morphine in 1 mL volume intrathecally. The ketamine group (group K) received 0.1 mg/kg ketamine in 1 mL volume instead of morphine. The morphine + ketamine group (group K + M) received both 0.3 mg morphine and 0.1 mg/kg ketamine in 1 mL volume intrathecally. Postoperative total morphine consumption, first request of analgesia, visual analog score (VAS), and side effects were recorded. Results Total PCA morphine was significantly decreased in group M + K compared with groups M and K. Time to first request of analgesia was prolonged in groups M and M + K compared with group K (P < 0.001). VAS in group M + K was reduced from two to 24 hours, and in group M from 12 and 18 hours postoperation compared with group K, with an overall good analgesia in the three groups. Sedation was significantly higher in group M + K compared with group M until six hours postoperation. No other side effects were observed. Conclusions Adding intrathecal ketamine 0.1 mg/kg to morphine 0.3 mg in patients who underwent major abdominal cancer surgery reduced the total postoperative morphine consumption in comparison with either drug alone, with an overall good postoperative analgesia in all groups, with no side effects apart from sedation.