Early and Late Postoperative Pain and Side Effects after Mastectomy: A Comparison of Ketamine and Thiamylal Administered for Anesthetic Induction

Tadasuke Use, Tetsuya Sakai, Hiroko Shimamoto, Taku Fukano, Koji Sumikawa

Department of Anesthesiology, Sasebo Kyosai Hospital, Nagasaki, Japan; 2Department of Anesthesiology, Nagasaki University School of Medicine, Nagasaki, Japan..

DOI: 10.4236/ojanes.2013.33044                

Abstract

Objective: To compare acute and long-term postoperative pain and side effects in patients undergoing mastectomy for breast cancer under general anesthesia induced with ketamine or thiamylal. Methods: Twenty four ASA physical status I-III patients undergoing mastectomy were randomly assigned to one of two groups. Ketamine group received intravenous ketamine, 1 mg/kg, and thiamylal group received intravenous thiamylal, 4 mg/kg, at the induction of general anesthesia. Anesthesia was maintained with sevoflurane, N₂O and fentanyl. The intensity of pain was assessed by using visual analog scale (VAS) 3 and 16 hr and 2, 3 and 4 weeks after surgery. Postoperative side effects, including nausea, vomiting and hallucination were also recorded. Results: At 16 hr after surgery, VAS in ketamine group was significantly lower than that in thiamylal group. However, there were no statistically significant differences between the two groups in the VAS at 3 hr and 2, 3 and 4 weeks after surgery. There were no differences in the incidence of side effects such as nausea, vomiting and hallucination between the two groups. Conclusion: Intravenous ketamine at the induction of anesthesia could reduce acute postoperative pain but not long-term pain after mastectomy.

Keywords

Preventive Analgesia; Ketamine; Mastectomy; Postoperative Pain; Anesthetic Induction

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	F. M. Perkins and H. Kehlet, “Chronic Pain as an Outcome of Surgery. A Review of Predictive Factors,” Anesthesiology, Vol. 93, No. 4, 2000, pp. 1123-1133. doi:10.1097/00000542-200010000-00038
[2]	A. B. Petrenko, T. Yamakura, H. Baba and K. Shimoji, “The Role of N-Methl-D Aspartate (NMDA) Receptors in Pain: A Review,” Anesthesia & Analgesia, Vol. 97, No. 4, 2003, pp. 1108-1116. doi:10.1213/01.ANE.0000081061.12235.55
[3]	C. J. Woolf and S. W. Thompson, “The Induction and Maintenance of Central Sensitization Is Dependent on N-Methyl-D-Aspartic Receptor Activation; Implications for the Treatment of Post-Injury Pain Hypersensitivity States,” Pain, Vol. 44, No. 3, 1991, pp. 293-299. doi:10.1016/0304-3959(91)90100-C
[4]	E. Kochs, E. Scharein, O. Mollenberg, B. Bromm and J. Schulte am Esch, “Analgesic Efficacy of Low-Dose Ketamine. Somatosensory-Evoked Responses in Relation to Subjective Pain Ratings,” Anesthesiology, Vol. 85, No. 2, 1996, pp. 304-314. doi:10.1097/00000542-199608000-00012
[5]	C. J. McCartney, A. Sinha and J. Katz, “A Qualitative Systematic Review of the Role of N-Methyl-D-Aspartate Receptor Antagonists in Preventive Analgesia,” Anesthesia & Analgesia, Vol. 98, No. 5, 2004, pp. 1385-1400. doi:10.1213/01.ANE.0000108501.57073.38
[6]	P. F. White, W. L. Way and A. J. Trevor, “Ketamine—Its Pharmacology and Therapeutic Uses,” Anesthesiology, Vol. 56, No. 2, 1982, pp. 119-136. doi:10.1097/00000542-198202000-00007
[7]	W. D. Ngan Kee, K. S. Khaw, M. L. Ma, P. A. Mainland and T. Gin, “Postoperative Analgesic Requirement after Cesarean Section: A Comparison of Anesthetic Induction with Ketamine or Thiopental,” Anesthesia & Analgesia, Vol. 85, No. 6, 1997, pp. 1294-1298.
[8]	R. F. Kwok, J. Lim, M. T. Chan, T. Gin and W. K. Chiu, “Preopetative Ketamine Improves Postoperative Analgesia after Gynecologic Laparoscopic Surgery,” Anesthesia & Analgesia, Vol. 98, No. 4, 2004, pp. 1044-1049. doi:10.1213/01.ANE.0000105911.66089.59
[9]	A. Stubhaug, H. Breivik, P. K. Eide, M. Kreunen and A. Foss, “Mapping of Punctuate Hyperalgesia around a Surgical Incision Demonstrates That Ketamine Is a Powerful Suppressor of Central Sensitization to Pain Following Surgery,” Acta Anaesthesiologica Scandinavica, Vol. 41, No. 9, 1997, pp. 1124-1132. doi:10.1111/j.1399-6576.1997.tb04854.x
[10]	D. G. Snijdelaar, H. B. Cornelisse, R. L. Schmid and J. Katz, “A Randomized Controlled Study of Peri-Operative Low Dose s(+)-Ketamine in Combination with Postoperative Patient-Controlled s(+)-Ketamine and Morphine after Radical Prostatectomy,” Anaesthesia, Vol. 59, No. 3, 2004, pp. 222-228. doi:10.1111/j.1365-2044.2003.03620.x
[11]	C. Menigaux, B. Guignard, D. Fletcher, D. I. Sessler, X. Dupont and M. Chauvin, “Intraoperative Small-Dose Ketamine Enhances Analgesia after Outpatient Knee Arthroscopy,” Anesthesia & Analgesia, Vol. 93, No. 3, 2001, pp. 606-612. doi:10.1097/00000539-200109000-00016
[12]	S. Aida, H. Baba, T. Yamakura, K. Taga, S. Fukuda and K. Shimoji, “The Effectiveness of Preemptive Analgesia Varies According to the Type of Surgery: A Randomized, Double-Blind Study,” Anesthesia & Analgesia, Vol. 89, No. 3, 1999, pp. 711-716.
[13]	O. N. Aydin, B. Ugur, S. Ozgun, H. Eyigor and O. Copcu, “Pain Prevention with Intraoperative Ketamine in Outpatient Children Undergoing Tonsillectomy or Tonsillectomy and Adenotomy,” Journal of Clinical Anesthesia, Vol. 19, No. 2, 2007, pp. 115-119. doi:10.1016/j.jclinane.2006.06.003
[14]	M. De Kock, P. Lavand’homme and H. Waterloos, “‘Balanced Analgesia’ in the Postoperative Period: Is There a Place for Ketamine?” Pain, Vol. 92, No. 3, 2001, pp. 373-380. doi:10.1016/S0304-3959(01)00278-0
[15]	M. Suzuki, S. Haraguti, K. Sugimoto, T. Kikutani, Y. Shimada and A. Sakamoto, “Low-Dose Intravenous Ketamine Potentiates Epidural Analgesia after Thoracotomy,” Anesthesiology, Vol. 105, No. 1, 2006, pp. 111-119. doi:10.1097/00000542-200607000-00020
[16]	J. A. Clements, W. S. Nimmo and I. S. Grant, “Bioavailability, Pharmacokinetics, and Analgesic Activity of Ketamine in Humans,” Journal of Pharmaceutical Sciences, Vol. 71, No. 5, 1982, pp. 539-542. doi:10.1002/jps.2600710516
[17]	F. Adam, M. Libier, T. Oszustowicz, D. Lefebvre, J. Beal and J. Meynadier, “Preoperative Small-Dose Ketamine Has No Preemptive Analgesic Effect in Patients Undergoing Total Mastectomy,” Anesthesia & Analgesia, Vol. 89, No. 2, 1999, pp. 444-447.
[18]	M. S. Angst and J. D. Clark, “Opioid-Induced Hyperalgesia: A Qualitative Systematic Review,” Anesthesiology, Vol. 104, No. 3, 2006, pp. 570-587. doi:10.1097/00000542-200603000-00025
[19]	Y. Y. Chia, K. Liu, J. J. Wang, M. C. Kuo and S. T. Ho, “Intraoperative High Dose Fentanyl Induces Postoperative Fentanyl Tolerance,” Canadian Journal of Anesthesia, Vol. 46, No. 9, 1999, pp. 872-877. doi:10.1007/BF03012978
[20]	J. P. Laulin, P. Maurette, J. B. Corcuff, C. Rivat, M. Chauvin and G. Simonnet, “The Role of Ketamine in Preventing Fentanyl-Induced Hyperalgesia and Subsequent Acute Morphine Tolerance,” Anesthesia & Analgesia, Vol. 94, No. 5, 2002, pp. 1263-1269. doi:10.1097/00000539-200205000-00040
[21]	R. L. Schmid, A. N. Sandler and J. Katz, “Use and Efficacy of Low-Dose Ketamine in the Management of Acute Postoperative Pain: A Review of Current Techniques and Outcomes,” Pain, Vol. 82, No. 2, 1999, pp. 111-125. doi:10.1016/S0304-3959(99)00044-5
[22]	N. Elia and M. R. Tramer, “Ketamine and Postoperative Pain—A Quantitative Systematic Review of Randomized Trials,” Pain, Vol. 113, No. 1-2, 2005, pp. 61-70. doi:10.1016/j.pain.2004.09.036