The effect of low-dose intravenous ketamine on continuous intercostal analgesia following thoracotomy

Annals of Cardiac Anaesthesia, 01/11/2012

Yazigi A et al. – Intravenous low-dose ketamine, when combined with continuous intercostal nerve block, did not decrease acute pain scores and supplemental morphine consumption following thoracotomy.


  • Sixty patients, undergoing elective lobectomy through an open posterolateral thoracotomy, were included.
  • For postoperative pain, all patients received a continuous intercostal nerve block with bupivacaine plus intravenous paracetamol and ketoprofen.
  • In addition, patients were randomized to have intravenous ketamine (0.1mg/kg as a preincisional bolus followed by a continuous infusion of 0.05mg/kg/h) in group 1 or intravenous placebo in group 2.


  • Patients reporting a visual analog scale pain score at rest ≥40mm received intravenous morphine sulfate as rescue analgesia.
  • The following parameters were assessed every 6hours for 3 postoperative days: Visual analog scale pain scores at rest and during coughing, requirement of rescue analgesia with morphine, Ramsay sedation scores and psychomimetic adverse effects.
  • Both the groups were statistically comparable regarding visual analog scale pain scores at rest (P=0.75) and during coughing (P=0.70), number of morphine deliveries (P=0.17), cumulative dose of rescue morphine (P=0.2), sedation scores (P=0.4), and psychomimetic adverse effects (P=0.09).

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