Effect of Ketamine Instillation on Acute and Chronic Post Mastectomy Pain, a Dose Finding Clinical Study ()
Affiliation(s)
1Department of Anesthesia, ICU and Pain Management, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
2Department of Anesthesia, ICU and Pain Management, Faculty of Medicine, Assuit University, Assiut, Egypt.
ABSTRACT
Background: Uncontrolled acute postoperative pain is considered a risk factor for the development of chronic pain afterward. Objectives: To explore the most effective dose of ketamine instillation (1 of 3 doses: 1, 2, or 3 mg/kg) for acute and chronic post mastectomy pain (PMP). Methods: Ninety female patients with cancer breast, aged (18 - 60 yrs), weighted (50 - 90 kg), scheduled for modified radical mastectomy, randomly allocated into 3 groups to receive ketamine instillation after surgical homeostasis before wound closure (1 of 3 doses; 1, 2, or 3 mg/kg as A, B or C groups respectively) patients were followed up for 48 h for acute pain (total morphine consumption, the first request of analgesia and visual analog scale at rest and movement (VASR/M), chronic pain by Leeds assessment of neuropathic signs and symptoms (LANSS) for six-months, hemodynamics, and side effects. Results: Median total dose of morphine consumption was 8 mg (5 - 10) versus 6 mg (6 - 7) in A and B groups respectively in the first 48 h postoperatively. Lowest VASR/M was recorded in C then B and lastly A group (P = 0.037). No patients in the C group requested analgesia versus thirty (100%) and nine (30%) patients in the A and B groups respectively with the first request of analgesia was 12 h (5 - 36) in the A group versus 30 h (12 - 36) in the B group respectively (P < 0.001). In the three studied groups, no patients in the C group had neuropathic pain versus 2 and 9 patients in B and A groups respectively (P ≤ 0.001) without serious side effects. Conclusion: Ketamine instillation effectively controlled acute post mastectomy pain (PMP) in a dose-dependent manner and reduced the incidence and severity of chronic pain in patients who undergoing a modified radical mastectomy.
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Sherif, F. , Elmorabaa, H. , Fares, K. , Mohamed, S. , Elgalaly, N. , Rezk, K. and Tohamy, M. (2022) Effect of Ketamine Instillation on Acute and Chronic Post Mastectomy Pain, a Dose Finding Clinical Study.
Open Journal of Anesthesiology,
12, 146-159. doi:
10.4236/ojanes.2022.124013.
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