Efficacy of adding ketamine to levobupivacaine in paravertebral block on acute and chronic pain in thoracotomy: a randomized controlled double-blinded trial.
Saad Ahmed Moharam, Amgad Elshikh, Mohamed Abdelbadie, Ahmed Mohamed Ibrahim, Mostafa Mohamed Khedr Shaheen, Mohammed Said Elsharkawy
PAIN Reports December 1, 2024 DOI: 10.1097/PR9.0000000000001206 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Double-blind Peer reviewed |
|---|---|
| Sample size | 60 |
| Population | Patients scheduled for open thoracotomy |
| Interventions | Ketamine Levobupivacaine |
| Dose | 50 mg |
| Duration | 48 hours for acute outcomes, with follow-up at 2 and 3 months for chronic pain |
| Topics | Ketamine Esketamine |
| Keywords | Levobupivacaine Paravertebral block Pain management pain Pain control Acute pain Chronic pain Immediate comfort Immediate pain relief Rescue medication Pain scores Standard block Anesthetic medications ketamine |
| Citations | 3 |
| Key findings | Adding ketamine to TPVB improved acute analgesia (delayed time to first rescue analgesia, lower opioid consumption, and lower pain scores) but did not affect chronic pain or complication rates at 2 and 3 months. |
Abstract
The inappropriate management of pain after thoracotomy results in serious complications. Several adjuvants have been added to the thoracic paravertebral block (TPVB) to enhance its effects. This work aimed to evaluate the effect of adding ketamine to TPVB on thoracotomy-related acute and chronic pain. This randomized controlled double-blinded trial included 60 patients scheduled for open thoracotomy. Patients were equally randomized into 2 groups: group K: received TPVB + 1 mL ketamine (50 mg). Group C (n = 30): received TPVB (19 mL of 0.5% levobupivacaine + 1 mL normal saline) as a control arm. Group K exhibited a significant delay in requesting analgesia, required less morphine in the first 24 and 48 hours, and reported lower numerical rating scale at rest and at deep breathing at various time points compared with the control group. However, both groups were comparable in post-thoracotomy pain syndrome and the incidence of complications at 2 months and 3 months. Adding ketamine to TPVB resulted in better analgesia as demonstrated by significantly delayed time to first rescue analgesia, lower total amount of consumed opioid, and pain score without considerable effect on chronic pain and complications in patients undergoing thoracotomy.
Comparable studies
Other randomized controlled trials on ketamine, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Subanesthetic Effects of the Noncompetitive NMDA Antagonist, Ketamine, in Humans Healthy human subjects recruited from the community | 1994 | Randomized controlled trial | n = 19 |
| Antidepressant Efficacy of Ketamine in Treatment-Resistant Major Depression: A Two-Site Randomized Controlled Trial Patients with treatment-resistant major depression experiencing a major depressive episode | 2013 | Randomized controlled trial | n = 73 |
| Remifentanil-induced Postoperative Hyperalgesia and Its Prevention with Small-dose Ketamine Patients undergoing major abdominal surgery | 2005 | Randomized controlled trial | n = 75 |
| Efficacy of Intravenous Ketamine for Treatment of Chronic Posttraumatic Stress Disorder Patients with chronic PTSD related to a range of trauma exposures | 2014 | Randomized controlled trial | n = 41 |
| Ketamine-Induced Deficits in Auditory and Visual Context-Dependent Processing in Healthy Volunteers Healthy volunteers | 2000 | Single-blind placebo-controlled study | n = 20 |