Opioid-sparing effect of preemptive bolus low-dose ketamine for moderate sedation in opioid abusers undergoing extracorporeal shock wave lithotripsy: a randomized clinical trial.

Abstract

BACKGROUND:

Ketamine has been used as part of a multimodal analgesia regime in opioid abusers undergoing general anesthesia. We studied the opioid-sparing effect of a very low-dose bolus of ketamine as part of moderate sedation for opioid abuse patients undergoing extracorporeal shock wave lithotripsy.

METHODS:

In this randomized, placebo-controlled clinical trial, 190 opioid abusers were enrolled. They were stratified into 2 blocks based on their daily opioid consumption. Both blocks were then randomized to receive 0.1 mg/kg IV ketamine (group K) or placebo (group P). Lithotripsy was performed under moderate sedation with intermittent bolus doses of remifentanil (0.2 µg/kg) to alleviate pain. The total remifentanil dose (primary outcome) and respiratory adverse events (secondary outcome) were compared in the 2 groups.

RESULTS:

Remifentanil administration in the group with low-opioid consumers was 1.6 ± 0.4 µg/kg (group P) compared with 1.0 ± 0.2 µg/kg in group K (confidence interval [CI](of difference) 95%, 0.4-0.7; P < 0.001). Patients who had high-opioid consumption received 2.0 ± 0.5 µg/kg (group P) vs 1.5 ± 0.3 µg/kg (group K) remifentanil (CI(of difference) 95%, 0.40-0.75; P < 0.001). Ready to discharge time was statistically longer in high-consumption opioid abusers who received placebo compared with group K (55 ± 13 minutes vs 44 ± 8 minutes, CI(of difference) 95%, 6-15; P < 0.001). The incidences of bradypnea, apnea, nausea, vomiting, and hemodynamic changes were not statistically different between the ketamine and placebo groups.

CONCLUSION:

Preemptive low-dose ketamine (0.1 mg/kg) as a bolus has opioid-sparing effects in opioid abusers undergoing moderate sedation.

• Authors: Babak Gharaei, Alireza Jafari, Homayoun Aghamohammadi, Mohammadreza Kamranmanesh, Mahtab Poorzamani, Hedayatollah Elyassi, Baharak Rostamian, Alireza Salimi
• Journal: Anesthesia and analgesia (Anesth Analg) Vol. 116 Issue 1 Pg. 75-80 (Jan 2013) ISSN: 1526-7598 [Electronic] United States
• PMID: 23223117 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Analgesics, Opioid
• Anesthetics, Dissociative
• Piperidines
• Ketamine
• Remifentanil

Topics

• Adolescent
• Adult
• Analgesia, Patient-Controlled
• Analgesics, Opioid (administration & dosage, therapeutic use)
• Anesthetics, Dissociative (therapeutic use)
• Conscious Sedation (methods)
• Double-Blind Method
• Female
• Hemodynamics (drug effects)
• Humans
• Injections, Intravenous
• Ketamine (therapeutic use)
• Lithotripsy (methods)
• Male
• Middle Aged
• Opioid-Related Disorders (complications)
• Pain Measurement
• Pilot Projects
• Piperidines (administration & dosage, therapeutic use)
• Postoperative Complications (epidemiology)
• Postoperative Nausea and Vomiting (epidemiology)
• Remifentanil
• Treatment Outcome
• Young Adult