Preemptive Low-dose Epidural Ketamine for Preventing... : The Clinical Journal of Pain (original) (raw)

Original Articles

Preemptive Low-dose Epidural Ketamine for Preventing Chronic Postthoracotomy Pain

A Prospective, Double-blinded, Randomized, Clinical Trial

Ryu, Ho-Geol MD*; Lee, Chul-Joong MD†; Kim, Young-Tae MD‡; Bahk, Jae-Hyon MD, PhD§

*Department of Anesthesiology and Pain Medicine, Boramae Medical Center, Seoul National University

†Department of Anesthesiology and Pain Medicine, Samsung Seoul Hospital, Sungkyunkwan University School of Medicine

Departments of ‡Thoracic and Cardiovascular Surgery

§Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea

This study was supported solely by departmental funds. The authors have no conflicts of interest to disclose.

Reprints: Jae-Hyon Bahk, MD, PhD, Seoul National University, College of Medicine, 101 Daehang-no, Jongno-gu, Seoul 110-744, Korea (e-mail: [email protected]).

Received June 4, 2010

Accepted September 19, 2010

Abstract

Objectives

Chronic postthoracotomy pain is the most common long-term complication that occurs after a thoracotomy with a reported incidence of up to 80%. Although thoracic epidural analgesia is a widely used method for managing acute postthoracotomy pain, its effects seems questionable. The objective of this prospective, double-blinded, randomized, controlled trial was to assess the effect of preemptive low-dose epidural ketamine in addition to preemptive thoracic epidural analgesia on the incidence of chronic postthoracotomy pain.

Methods

We analyzed 133 patients who were randomized to preemptive thoracic epidural analgesia either with or without ketamine (Group K: 0.12% levobupivacaine, 2 μg/mL of fentanyl, 0.2 mg/mL ketamine, total volume of 500 mL vs. Group KF: 0.12% levobupivacaine, 2 μg/mL of fentanyl, total volume of 500 mL). Pain at the thoracotomy scar site during rest and movement (coughing) was assessed at 2 weeks and 3 months after surgery using a visual analog scale. The incidence of allodynia and numbness was also evaluated.

Results

There was no difference in the incidence of chronic postthoracotomy pain at 3 months between the 2 groups (67.7% in group K vs. 75% in group KF). The incidences of allodynia or numbness were not different between the 2 groups.

Discussion

The addition of preemptive low-dose epidural ketamine (1.2 mg/h) to preemptive thoracic epidural analgesia did not have any beneficial effects in preventing chronic postthoracotomy pain.