Effect of magnesium sulfate with ketamine infusions on intraoperative and postoperative analgesia in cancer breast surgeries: a randomized double-blind trial
Efeito do sulfato de magnésio com infusões de cetamina na analgesia intra e pós-operatória em cirurgias de câncer de mama: um estudo duplo-cego randomizado
Mohamed Elsayed Hassan; Essam Mahran
Abstract
Background
Opioids are the cornerstone in managing postoperative pain; however, they have many side effects. Ketamine and Magnesium (Mg) are NMDA receptor antagonists used as adjuvant analgesics to decrease postoperative opioid consumption.
Objective
We assumed that adding Mg to ketamine infusion can improve the intraoperative and postoperative analgesic efficacy of ketamine infusion alone in cancer breast surgeries.
Methods
Ninety patients aged between 18 and 65 years and undergoing elective cancer breast surgery were included in this prospective randomized, double-blind study. Group K received ketamine 0.5 mg.kg-1 bolus then 0.12 mg.kg-1. h-1 infusion for the 1st 24 hours postoperatively. Group KM: received ketamine 0.5 mg.kg-1 and Mg sulfate 50 mg.kg-1, then ketamine 0.12 mg.kg-1. h-1 and Mg sulfate 8 mg.kg-1. h-1 infusions for the 1st 24 hours postoperative. The primary outcome was the morphine consumption in the 1st 24 hours postoperative, while the secondary outcomes were: intraoperative fentanyl consumption, NRS, side effects, and chronic postoperative pain.
Results
Group KM had less postoperative opioid consumption (14.12 ± 5.11 mg) than Group K (19.43 ± 6.8 mg). Also, Group KM had less intraoperative fentanyl consumption. Both groups were similar in postoperative NRS scores, the incidence of side effects related to opioids, and chronic neuropathic pain.
Conclusion
Adding Mg to ketamine infusion can safely improve intraoperative and postoperative analgesia with opioid-sparing effect in cancer breast surgery.
Keywords
Resumo
Introdução
Os opioides são a pedra angular no controle da dor pós-operatória; no entanto, eles têm muitos efeitos colaterais. A cetamina e o magnésio (Mg) são antagonistas dos receptores NMDA usados como analgésicos adjuvantes para diminuir o consumo de opioides no pós-operatório.
Objetivo
Assumimos que a adição de Mg à infusão de cetamina pode melhorar a eficácia analgésica intra e pós-operatória da infusão de cetamina isoladamente em cirurgias de câncer de mama.
Métodos
Noventa pacientes com idades entre 18 e 65 anos e submetidas a cirurgia eletiva de câncer de mama foram incluídas neste estudo prospectivo, randomizado e duplo-cego. O grupo K recebeu cetamina 0,5 mg.kg-1 em bolus e depois 0,12 mg.kg-1.h-1 em infusão nas primeiras 24 horas de pós-operatório. Grupo KM: recebeu cetamina 0,5 mg.kg-1 e sulfato de Mg 50 mg.kg-1, depois cetamina 0,12 mg.kg-1.h-1 e sulfato de Mg 8 mg.kg-1.h-1 na primeira infusão 24 horas de pós-operatório. O desfecho primário foi o consumo de morfina nas primeiras 24 horas de pós-operatório, enquanto os desfechos secundários foram: consumo intraoperatório de fentanil, escala numérica da dor, efeitos colaterais e dor crônica pós-operatória.
Resultados
O grupo KM apresentou menor consumo de opioides no pós-operatório (14,12 ± 5,11 mg) do que o grupo K (19,43 ± 6,8 mg). Além disso, o Grupo KM apresentou menor consumo de fentanil intraoperatório. Ambos os grupos foram semelhantes nos escores pós-operatórios da escala numérica da dor, na incidência de efeitos colaterais relacionados aos opioides e na dor neuropática crônica.
Conclusão
A adição de Mg à infusão de cetamina pode melhorar com segurança a analgesia intra e pós-operatória com efeito poupador de opioides em cirurgia de câncer de mama.
Palavras-chave
References
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Submitted date:
11/02/2020
Accepted date:
07/17/2021
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