Preoperative Oral Morphine and Sub-Anesthetic Ketamine Co-Administration Reduce Acute Post-Mastectomy Pain
Montaser A Mohammad, Diab Fuad Hetta*, Rania M Abd Elemam and Shereen Mamdouh Kamal
Department of Anesthesia and Pain Management, South Egypt Cancer Institute, Assuit University, Egypt
- *Corresponding Author:
- Diab Fuad Hetta
Department of Anesthesia and Pain Management
South Egypt Cancer Institute
Assuit University, Egypt
E-mail: [email protected]
Received date: May 04, 2017; Accepted date: May 24, 2017; Published date: May 26, 2017
Citation: Mohammad MA, Hetta DF, Abd-Elemam RM, Kamal SM (2017) Preoperative Oral Morphine and Sub-Anesthetic Ketamine Co- Administration Reduce Acute Post-Mastectomy Pain. J Anesth Clin Res 8:728. doi:10.4172/2155-6148.1000728
Copyright: © 2017 Mohammad MA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Objectives: To assess the analgesic efficacy and tolerability of co-administration of pre-emptive single oral dose of sustained release morphine and sub- anesthetic ketamine infusion for modified radical mastectomy (MRM) with axillary evacuation.
Methods: Sixty four adult female patients scheduled for MRM were divided to two groups, morphine group (n=32) received preoperative oral sustained release morphine tablet, 30 mg and placebo group (n=32) received placebo tablet. Both groups received preoperative ketamine bolus, 0.5 mg/kg followed by continuous infusion 0.1 mg/kg/h for 24 h postoperatively. VAS pain score, time to first analgesic request, 24 h analgesic consumption were reported.
Results: The mean VAS pain score during movement was significantly decreased in morphine group in comparison to placebo group from 2 h till 72 h postoperatively, 2 h (2.87 ± 1.0 vs. 4.53 ± 1.67) mean difference (-1.67) (95% CI)-(2.38-0.95), 72 h (1.20 ± 0.76 vs. 1.83 ± 0.91) mean difference (-0.63) (95% CI)-(1.07-0.20) while the mean VAS pain score during rest was significantly decreased in morphine group in comparison to placebo group from 2 h till 24 h postoperatively, 2 h (2.03 ± 0.85 vs. 3.47 ± 0.93) mean difference (-1.33) (95% CI)-(1.78-0.90), 24 h (1.40 ± 0.72 vs. 1.77 ± 0.68) mean difference (-0.37) (95% CI)-(0.73-0.01).
The median (IQ) time to first analgesic request was significantly delayed in morphine group in comparison to placebo group, 11.8 (9.7:14.2) h vs. 2.3 (2.1:2.5) h, (P<0.001).
The number (percentage) of patients required paracetamol in the first postoperative 24 h was significantly lower in morphine group in comparison to placebo group, 10 (33%) vs. 30 (100 %) (P<0.001).
Conclusion: Analgesic technique based on pre-emptive sustained release oral morphine and perioperative infusion of sub-anesthetic dose of ketamine provides satisfactory analgesia for patients undergoing MRM.