Author(s)

Fatma El Sherif¹, Hany Elmorabaa², Khaled Mohamed Fares¹, Sahar Abdel-Baky Mohamed¹, Nourhan M. Elgalaly¹, Khalid Rezk¹, Moaaz Tohamy^1*

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.

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.

Acute Pain, Breast Cancer, Chronic Pain, Ketamine Instillation, Modified Radical Mastectomy

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.