The effectiveness of Patient Controlled Analgesia (PCA) morphine-ketamine compared to Patient Controlled Analgesia (PCA) morphine to reduce total dose of morphine and Visual Analog Scale (VAS) in postoperative laparotomy surgery
Journal Title: Bali Journal of Anesthesiology - Year 2017, Vol 1, Issue 2
Abstract
Laparotomy may cause moderate to severe after surgery pain, thus adequate pain management is needed. The addition of ketamine in patient controlled analgesia (PCA) morphine after surgery can be the option. This study aims to evaluate the effectiveness of PCA morphine-ketamine compared to PCA morphine in patient postoperative laparotomy surgery to reduce total dose of morphine requirement and pain intensity evaluated with visual analog scale (VAS). Methods: This study was a double-blind RCT in 58 patients of ASA I and II, age 18-64 years, underwent an elective laparotomy at Sanglah General Hospital. Patients were divided into 2 groups. Group A, got addition of ketamine (1mg/ml) in PCA morphine (1mg/ml) and patients in group B received morphine (1mg/ml) by PCA. Prior to surgical incision both group were given a bolus ketamine 0,15mg/ kg and ketorolac 0,5mg/kg. The total dose of morphine and VAS were measured at 6, 12, and 24 hours postoperatively. Result: Total dose of morphine in the frst 24 hours postoperatively at morphine-ketamine group (5,1±0,8mg) is lower than morphine only group (6,5±0,9mg) p<0,001. VAS (resting) 6 and 12 hour postoperative in morphine-ketamine group (13,4±4,8 mm) and (10,7±2,6 mm) are lower than morphine (17,9±4,1mm) p≤0,05 and (12,8±5,3mm) p≤0,05. VAS (moving) 6, 12, and 24 hour postoperative morphineketamine group (24,8±5,1mm), (18±5,6mm) and (9±5,6mm) are lower than morphine (28,7±5,2mm) p≤0,05, (23,1±6,0mm) p≤0,05, and (12,8±5,3mm) p≤0,05. Conclusions: Addition of ketamine in PCA morphine for postoperative laparotomy surgery reduces total morphine requirements in 24 hours compared to PCA morphine alone.
Establishing good rapport in anesthesia-related doctor-patient communication: bridging the triangular communication between anesthesiologist-surgeon-patient
Doctor-patient communication is central in clinical practice. Communication skill has been an essential component of clinical competence to become a five-star doctor. In the other hand, there are major problems in doctor...
THE SIGNIFICANCE OF MODIFIED PIRO SCORING WITH NLR BIOMARKER ON ENHANCING MORTALITY PREDICTION OF PATIENTS WITH VENTILATORS‑ASSOCIATED PNEUMONIA IN INTENSIVE CARE UNIT
Ventilator-associated pneumonia (VAP) is a pulmonary infection that occurs as a mechanical ventilator-related disease which accounts for almost 80% of hospital-acquired pneumonia with of high mortality rate, lengthens th...
PERIOPERATIVE EFFECTS OF CO-ADMINISTRATION OF TCI PROPOFOL COMBINED WITH CLONIDINE AND KETAMINE
Background: Propofol is often used in Total Intravenous Anesthesia (TIVA). Studies found that adding clonidine and ketamine can increase the potential to achieve an adequate level of anesthesia while reducing inflammation...
POSITIONING OF FRACTURE FEMUR PATIENTS FOR SPINAL ANESTHESIA: FEMORAL NERVE BLOCK OR INTRAVENOUS FENTANYL?
Background: Fracture of the femur is a common, but extremely painful bone injury. Anaesthesiologists face the common problem of improper positioning of the patient while giving sitting spinal due to their extreme pain. M...
Extended glasgow outcome scale and correlation with bispectral index
Traumatic brain injury (TBI) is a major public health issue, which results in signifcant mortality and long-term disability. The profound impact of TBI is not only felt by the individuals who suffer the injury but also th...