Preemptive Use of Diclofenac in Combination With Ketamine in Patients Undergoing Laparoscopic Cholecystectomy: A Randomized, Double-blind, Placebo-controlled Study
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 06/08/2012
Nesek–Adam V et al. – The preemptive administration of a combination of low–dose ketamine plus diclofenac sodium improved postoperative analgesia after laparoscopic cholecystectomy, whereas ketamine at a dose of 0.15 mg/kg did not elicit a preemptive analgesic effect.Methods
- A total of 80 consecutive patients, American Society of Anesthesiologists physical status I or II, were recruited to the study.
- Patients were randomized to one of the following groups: group 1 received 100–mL isotonic saline intravenously (i.v.) 20 minutes before the induction of anesthesia and 5–mL isotonic saline i.v. before skin incision as a placebo; group 2 received 100–mL isotonic saline i.v. 20 minutes before the induction of anesthesia and 0.15–mg/kg ketamine diluted in 5–mL isotonic saline i.v. before skin incision; group 3 received diclofenac 1 mg/kg diluted in 100–mL isotonic saline i.v. 20 minutes before the induction of anesthesia and 5–mL isotonic saline i.v. before skin incision; and group 4 received a combination of the same diclofenac sodium and ketamine doses at the same time.
- Abdominal and shoulder pain intensity was assessed using the visual analog scale and verbal rating scale during 24 hours postoperatively.
- Patients receiving diclofenac had a significantly lower pain score between 2 and 6 hours after surgery compared with patients receiving placebo.
- One hour after surgery, patients receiving a combination of diclofenac and ketamine had a significantly lower pain score compared with patients receiving placebo and ketamine alone.
- Patients from all the 4 study groups required postoperative analgesic; however, the time to diclofenac sodium request was longer in patients receiving a combination of diclofenac and ketamine compared with patients receiving placebo (p<0.001), ketamine (p<0.001), or diclofenac (p=0.03) alone.