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Effect of a low-dose ketamine regimen on pain, mood, cognitive function and memory after major gynaecological surgery: a randomized, double-blind, placebo-controlled trial

Aubrun, F.*; Gaillat, C.*; Rosenthal, D.*; Dupuis, M.*; Mottet, P.*; Marchetti, F.*; Coriat, P.*; Riou, B.

European Journal of Anaesthesiology (EJA): February 2008 - Volume 25 - Issue 2 - p 97–105
doi: 10.1017/S0265021507002566
Original Article

Background and objective: Major gynaecological abdominal surgery is associated with moderate to severe postoperative pain, hyperalgesia and the need for multimodal analgesia to reduce high morphine consumption. A low-dose ketamine regimen appears to prevent postoperative hyperalgesia. We examined the potential beneficial effect of ketamine on postoperative pain management and cognitive function.

Methods: Ninety patients were included in this double-blind, randomized, placebo-controlled study to test the efficacy and adverse effects of ketamine (as an intraoperative bolus of 0.15 mg kg−1, followed postoperatively by ketamine 0.5 mg per morphine 1 mg in a patient-controlled analgesia device). All patients received additionally ketoprofen. The main end-point was morphine consumption over the first 24 h. Secondary efficacy and safety end-points were morphine consumption during the titration period and during the patient-controlled analgesia period (48 h), the number of morphine-related adverse effects and the results of psychometric tests.

Results: Ketamine, in combination with morphine and ketoprofen, did not improve postoperative pain scales and did not reduce morphine consumption and the incidence of morphine-related adverse effects. Ketamine did not modify mood, cognitive and memory functioning.

Conclusion: Adding a low dose of ketamine to an efficacious multimodal analgesic regimen did not improve analgesia after gynaecological surgery. Although this combination appears to be safe, the lack of benefit suggests that a low dose of ketamine should not be used for routine care.

*Université Pierre et Marie Curie-Paris 6, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe hospitalier Pitié-Salpětrière, Department of Anesthesiology and Critical Care, Paris, France

Université Pierre et Marie Curie-Paris 6, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe hospitalier Pitié-Salpětrière, Department of Emergency Medicine and Surgery, Paris, France

Correspondence to: Frédéric Aubrun, Département d'Anesthésie-Réanimation, CHU Pitié-Salpětrière, 47 Boulevard de l'Hôpital, 75651 Paris Cedex 13, France. E-mail: frederic.aubrun@psl.ap-hop-paris.fr; Tel: +33 1 42 16 22 59; Fax: +33 1 42 16 22 69

Accepted for publication 1 August 2007

First published online 26 September 2007

© 2008 European Society of Anaesthesiology