Resumo

CHAPARRO, Luis Enrique et al. Efectividad de la ketamina para reducir los requerimientos perioperatorios de opioides: Un ensayo clínico doble ciego, controlado con placebo. Rev. colomb. anestesiol. [online]. 2005, vol.33, n.3, pp.169-174. ISSN 0120-3347.

Aim of Investigation: Acute opioid tolerance have been reported with remifentanil-based anesthesia techniques. We evaluate the perioperative effect of a racemic ketamine bolus and infusion in perioperative opioid requirements for patients undergoing augmentation mammaplasty with remifentanil/sevorane anesthesia technique. Methods: After institutional Ethical Committee approval and informed consent, a total of 106 women undergoing augmentation mammaplasty under general anesthesia from April until December 2004, at an ambulatory surgery unit were studied. Patients were randomized in a double blind fashion to receive placebo (Group RP) or ketamine preoperative bolus of 0.5 mg/kg followed by an infusion of 0.20 mg/kg/h (Group RK) plus remifentanil during surgery. Remifentanil (intraoperative) and Meperidine (postoperative) consumption, pain scores (visual analogue scale, VAS), and adverse effects were recorded every 15 min until discharge of surgery. Results: Cumulative intraoperative consumption of Remifentanil was lower in the ketamine/Remifentanil group (0.14 vs 0.16 ug/kg/min, p=0.038). Cumulative Meperidine consumption was lower too (17.9 vs 29.1 mg) but did not reached statistical significant difference (p=0.06). Pain scores after surgery were significantly lower in the same group (2.8 vs 3.9, p=0.03) but only 15 min after surgery. No significant differences were found in adverse effects. Open eyes was earlier in Remifentanil/Saline group (7.5 vs 6.3 min, p=0.026). Conclusions: To add racemic ketamine helps to decrease intraoperative and postoperative opioid consumption but didn't reached clinical important differences in patients undergoing augmentation mammaplasty. The same occurred with pain scores.

Palavras-chave : Analgesics; Opioid/adverse effects; Hyperalgesia/chemically induced; Ketamine/administration & dosage.

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