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Effect of ketamine instillation on Acute and Chronic Post Mastectomy Pain, a Dose Finding Clinical Study

Open Journal of Anesthesiology 2022年第4期12卷 146-159页

作者： Fatma El Sherif Hany Elmorabaa Khaled Mohamed Fares Sahar Abdel-Baky Mohamed Nourhan M. Elgalaly Khalid Rezk Moaaz Tohamy Department of Anesthesia ICU and Pain Management South Egypt Cancer Institute Assiut University Assiut Egypt Department of Anesthesia ICU and Pain Management Faculty of Medicine Assuit University Assiut Egypt

Background: Uncontrolled acute postoperative pain is considered a risk factor for the development of chronic pain afterward. Objectives: To explore the most effective dose of ketamine instillation (1 of 3 doses: 1, 2, or 3 mg/kg) for acute and chronic post mastectomy pain (PMP). Methods: Ninety female patients with cancer breast, aged (18 - 60 yrs), weighted (50 - 90 kg), scheduled for modified radical mastectomy, randomly allocated into 3 groups to receive ketamine instillation after surgical homeostasis before wound closure (1 of 3 doses;1, 2, or 3 mg/kg as A, B or C groups respectively) patients were followed up for 48 h for acute pain (total morphine consumption, the first request of analgesia and visual analog scale at rest and movement (VASR/M), chronic pain by Leeds assessment of neuropathic signs and symptoms (LANSS) for six-months, hemodynamics, and side effects. Results: Median total dose of morphine consumption was 8 mg (5 - 10) versus 6 mg (6 - 7) in A and B groups respectively in the first 48 h postoperatively. Lowest VASR/M was recorded in C then B and lastly A group (P = 0.037). No patients in the C group requested analgesia versus thirty (100%) and nine (30%) patients in the A and B groups respectively with the first request of analgesia was 12 h (5 - 36) in the A group versus 30 h (12 - 36) in the B group respectively (P Conclusion: ketamine instillation effectively controlled acute post mastectomy pain (PMP) in a dose-dependent manner and reduced the incidence and severity of chronic pain in patients who undergoing a modified radical mastectomy.

关键词： Acute Pain Breast Cancer Chronic Pain ketamine instillation Modified Radical Mastectomy

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