The Comparison of Preventive Analgesic Effects of Ketamine, Paracetamol and Magnesium Sulfate on Postoperative Pain Control in Patients Undergoing Lower Limb Surgery: A Randomized Clinical Trial

Document Type : Original Article

Authors

Department of Anesthesiology and Intensive Care Unit, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: In considering the importance of postoperative pain management and its consequences on its related secondary outcomes including nausea, vomiting, and operation-related complications, we aimed to compare the effectiveness of the three analgesic agents including ketamine, paracetamol, and magnesium sulfate for postoperative pain relief and associated consequences in this trial. Materials and Methods: In this double-blinded randomized control clinical trial, patients scheduled for elective lower extremity orthopedic surgery under general anesthesia were enrolled and randomized into four groups for receiving intravenous ketamine (0.25 mg/kg), paracetamol (15 mg/kg), magnesium sulfate (7.5 mg/kg), and placebo (normal saline), immediately after the induction of anesthesia. Postoperative pain scores, analgesic, and metoclopramide use, and frequency of vomiting and satisfaction score of studied patients in the four studied groups during the 6 h, 6–12 h, and 12–24 h after recovery were recorded and compared. Results: In this trial, thirty patients randomized in each studied groups. Mean of postoperative pain score was significantly lower in ketamine group than others during 24 h after recovery (P < 0.001). Mean of additive analgesic use was significantly lower in ketamine group during 12 h after recovery (P < 0.001), but it was not significantly different during 12–24 h after recovery (P = 0.12). Mean of vomiting frequency and metoclopramide use was not different between groups (P > 0.05). Excellent and good satisfaction score were significantly higher in ketamine group than other groups (P = 0.04). Conclusions: Ketamine has more superior effect for during recovery and postoperative pain controlling and analgesic use than paracetamol and magnesium sulfate.

Keywords

1.
Vadivelu N, Mitra S, Schermer E, Kodumudi V, Kaye AD, Urman RD. Preventive analgesia for postoperative pain control: A broader concept. Local Reg Anesth 2014;7:17-22.  Back to cited text no. 1
[PUBMED]    
2.
Carr DB, Goudas LC. Acute pain. Lancet 1999;353:2051-8.  Back to cited text no. 2
[PUBMED]    
3.
Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: Results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg 2003;97:534-40.  Back to cited text no. 3
[PUBMED]    
4.
Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery. Lancet 2003;362:1921-8.  Back to cited text no. 4
[PUBMED]    
5.
Holte K, Kehlet H. Postoperative ileus: A preventable event. Br J Surg 2000;87:1480-93.  Back to cited text no. 5
[PUBMED]    
6.
Gandhi K, Heitz JW, Viscusi ER. Challenges in acute pain management. Anesthesiol Clin 2011;29:291-309.  Back to cited text no. 6
[PUBMED]    
7.
American Society of Anesthesiologists Task Force on Acute Pain Management. Practice guidelines for acute pain management in the perioperative setting: An updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology 2012;116:248-73.  Back to cited text no. 7
[PUBMED]    
8.
Lucas CE, Vlahos AL, Ledgerwood AM. Kindness kills: The negative impact of pain as the fifth vital sign. J Am Coll Surg 2007;205:101-7.  Back to cited text no. 8
[PUBMED]    
9.
Taylor RS, Ullrich K, Regan S, Broussard C, Schwenkglenks M, Taylor RJ, et al. The impact of early postoperative pain on health-related quality of life. Pain Pract 2013;13:515-23.  Back to cited text no. 9
[PUBMED]    
10.
Ong CK, Lirk P, Seymour RA, Jenkins BJ. The efficacy of preemptive analgesia for acute postoperative pain management: A meta-analysis. Anesth Analg 2005;100:757-73.  Back to cited text no. 10
[PUBMED]    
11.
Hariharan S, Moseley H, Kumar A, Raju S. The effect of preemptive analgesia in postoperative pain relief – A prospective double-blind randomized study. Pain Med 2009;10:49-53.  Back to cited text no. 11
[PUBMED]    
12.
Dullenkopf A, Müller R, Dillmann F, Wiedemeier P, Hegi TR, Gautschi S. An intraoperative pre-incision single dose of intravenous ketamine does not have an effect on postoperative analgesic requirements under clinical conditions. Anaesth Intensive Care 2009;37:753-7.  Back to cited text no. 12
    
13.
Koh W, Nguyen KP, Jahr JS. Intravenous non-opioid analgesia for peri- and postoperative pain management: A scientific review of intravenous acetaminophen and ibuprofen. Korean J Anesthesiol 2015;68:3-12.  Back to cited text no. 13
[PUBMED]    
14.
Han JU. About uses of magnesium during perioperative period. Korean J Anesthesiol 2012;62:509-11.  Back to cited text no. 14
[PUBMED]    
15.
Jouguelet-Lacoste J, La Colla L, Schilling D, Chelly JE. The use of intravenous infusion or single dose of low-dose ketamine for postoperative analgesia: A review of the current literature. Pain Med 2015;16:383-403.  Back to cited text no. 15
[PUBMED]    
16.
Albrecht E, Kirkham KR, Liu SS, Brull R. Peri-operative intravenous administration of magnesium sulphate and postoperative pain: A meta-analysis. Anaesthesia 2013;68:79-90.  Back to cited text no. 16
    
17.
Sinatra RS, Jahr JS, Reynolds LW, Viscusi ER, Groudine SB, Payen-Champenois C. Efficacy and safety of single and repeated administration of 1 gram intravenous acetaminophen injection (paracetamol) for pain management after major orthopedic surgery. Anesthesiology 2005;102:822-31.  Back to cited text no. 17
[PUBMED]    
18.
Gregoire N, Hovsepian L, Gualano V, Evene E, Dufour G, Gendron A. Safety and pharmacokinetics of paracetamol following intravenous administration of 5 g during the first 24 h with a 2-g starting dose. Clin Pharmacol Ther 2007;81:401-5.  Back to cited text no. 18
[PUBMED]    
19.
Brodner G, Gogarten W, Van Aken H, Hahnenkamp K, Wempe C, Freise H, et al. Efficacy of intravenous paracetamol compared to dipyrone and parecoxib for postoperative pain management after minor-to-intermediate surgery: A randomised, double-blind trial. Eur J Anaesthesiol 2011;28:125-32.  Back to cited text no. 19
    
20.
De Oliveira GS Jr., Castro-Alves LJ, Khan JH, McCarthy RJ. Perioperative systemic magnesium to minimize postoperative pain: A meta-analysis of randomized controlled trials. Anesthesiology 2013;119:178-90.  Back to cited text no. 20
    
21.
Rezae M, Naghibi K, Taefnia AM. Effect of pre-emptive magnesium sulfate infusion on the post-operative pain relief after elective cesarean section. Adv Biomed Res 2014;3:164.  Back to cited text no. 21
[PUBMED]  [Full text]  
22.
Dabbagh A, Elyasi H, Razavi SS, Fathi M, Rajaei S. Intravenous magnesium sulfate for post-operative pain in patients undergoing lower limb orthopedic surgery. Acta Anaesthesiol Scand 2009;53:1088-91.  Back to cited text no. 22
    
23.
Shariat Moharari R, Motalebi M, Najafi A, Zamani MM, Imani F, Etezadi F, et al. Magnesium can decrease postoperative physiological ileus and postoperative pain in major non laparoscopic gastrointestinal surgeries: A randomized controlled trial. Anesth Pain Med 2013;4:e12750.  Back to cited text no. 23
    
24.
Radvansky BM, Shah K, Parikh A, Sifonios AN, Le V, Eloy JD. Role of ketamine in acute postoperative pain management: A narrative review. Biomed Res Int 2015;2015:749837.  Back to cited text no. 24
    
25.
Singh H, Kundra S, Singh RM, Grewal A, Kaul TK, Sood D. Preemptive analgesia with Ketamine for Laparoscopic cholecystectomy. J Anaesthesiol Clin Pharmacol 2013;29:478-84.  Back to cited text no. 25
[PUBMED]  [Full text]  
26.
Yang L, Zhang J, Zhang Z, Zhang C, Zhao D, Li J. Preemptive analgesia effects of ketamine in patients undergoing surgery. A meta-analysis. Acta Cir Bras 2014;29:819-25.  Back to cited text no. 26
    
27.
Safavi M, Honarmand A, Nematollahy Z. Pre-incisional analgesia with intravenous or subcutaneous infiltration of ketamine reduces postoperative pain in patients after open cholecystectomy: A randomized, double-blind, placebo-controlled study. Pain Med 2011;12:1418-26.  Back to cited text no. 27
    
28.
Reza FM, Zahra F, Esmaeel F, Hossein A. Preemptive analgesic effect of ketamine in patients undergoing elective cesarean section. Clin J Pain 2010;26:223-6.  Back to cited text no. 28
    
29.
Helmy N, Badawy AA, Hussein M, Reda H. Comparison of the preemptive analgesia of low dose ketamine versus magnesium sulfate on parturient undergoing cesarean section under general anesthesia. Egypt J Anaesth 2015;31:53-8.  Back to cited text no. 29