Volume 13, Issue 3 (10-2024)                   Int J Med Invest 2024, 13(3): 57-66 | Back to browse issues page

XML Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Malekshoar M, Zarei T, Razavi B M, Pourbahri M, Sayadinia M, Hamidi M et al . Effect Of Adding Intravenous Ketamine To Methadone For Postoperative Pain In Opioid Addicts After Major Surgery: A Double-Blind Randomized Control Clinical Trial Study. Int J Med Invest 2024; 13 (3) :57-66
URL: http://intjmi.com/article-1-1182-en.html
Abstract:   (269 Views)
Background: The purpose of this study is to investigate the effect of adding intravenous ketamine to methadone in controlling the pain of opium-addicted patients after major surgery in the intensive care unit (ICU) of Shahid Mohammadi Hospital.
Methods: In a rigorously controlled clinical investigation, a randomized, double-blinded study design was employed to evaluate a total of 89 opium-addicted patients were included in the study after major surgery in the Shahid Mohammadi Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. Richmond Agitation-Sedation Scale (RASS) and pain intensity were measured repeatedly till 24 hours.
Results: Eighty-nine patients were included in this study. Intervention and control groups need for morphine was statistically different. Average pain of study groups varied at 1, 6, 12, and 24 hours after surgery (P<0.05), as well as the average RASS (P<0.05), both RASS and pain indices were lower in intervention group than controls.
Conclusion: The findings of the current investigation reveal that adding intravenous ketamine to methadone controls pain and reduces the need for morphine in opium-addicted patients after major surgery in the intensive care unit without serious side effects. Therefore, this combination can be used in this group of patients to reduce pain and reduce recovery time.
 
Full-Text [PDF 397 kb]   (108 Downloads)    
Type of Study: Research | Subject: General

References
1. 1. Holdcroft A, Power I. Management of pain. BMJ. 2003;326(7390):635-9. 2. Stoelting RK. Acute postoperative pain management. Basics of Anesthesia. 1994. 3. Malekshoar M, Shafa S, Jahromi M G, Vatankhah M, Adibi P. Pain Control In Patients Undergoing Orthopedic Surgery: A Narrative Review Study On The Role Of Anesthetics. Int J Med Invest 2021; 10 (4) :41-49. 4. Beauregard L, Pomp A, Choinière M. Severity and impact of pain after day-surgery. Canadian Journal of Anaesthesia. 1998;45(4):304-11. 5. Rosero EB, Joshi GP. Preemptive, preventive, multimodal analgesia: what do they really mean? Plastic and reconstructive surgery. 2014;134(4S-2):85S-93S. 6. Annetta MG, Iemma D, Garisto C, Tafani C, Proietti R. Ketamine: new indications for an old drug. Current drug targets. 2005;6(7):789-94. 7. Ivani G, Vercellino C, Tonetti F. Ketamine: a new look to an old drug. Minerva anestesiologica. 2003;69(5):468-71. 8. Marx J, Hockberger R, Walls R. Rosen's Emergency Medicine-Concepts and Clinical Practice E-Book: 2-Volume Set: Elsevier Health Sciences; 2013. 9. Granry J-C, Dube L, Turroques H, Conreux F. Ketamine: new uses for an old drug. Current Opinion in Anesthesiology. 2000;13(3):299-302. 10. Pino RM. The nature of anesthesia and procedural sedation outside of the operating room. Current Opinion in Anesthesiology. 2007;20(4):347-51. 11. Rosen P, Barkin RM, Danzl DF. Emergency medicine: concepts and clinical practice: Mosby; 1998. 12. Greene SA. Chronic pain: pathophysiology and treatment implications. Topics in companion animal medicine. 2010;25(1):5-9. 13. Bowdle TA, Even A, Shen DD, Swardstrom M. Methadone for the induction of anesthesia: plasma histamine concentration, arterial blood pressure, and heart rate. LWW; 2004. p. 1692-7. 14. Li L, Liang L-J, Lin C, Feng N, Cao W, Wu Z. An intervention to improve provider-patient interaction at methadone maintenance treatment in China. Journal of substance abuse treatment. 2019;99:149-55. 15. Waldman, S.D. Pain management :expert consult 2011:Elsevier health sciences 10-18. 16. Owezarzak V, Haddad J (2006) Comparison of oral versus rectal administration of acetaminophen with codeine in postoperative pediatric adenotonsillectomy patients. Laryngoscope 116:1485–1488 17. Pickering AE, Dridge HS, Nolan J, Stoddart PA (2002) Double-blin placebocontrolled analgesic study of ibuprofen or rofecoxib in combination with paracetamol for tonsillectomy in children. Br J Anaesth 88:72–77 18. Borgeat A, Ekatodramis G. Anaesthesia for shoulder surgery. Best Pract Res Clin Anaesthesiol 2002;16(2):211-25 19. Burkhart SS. Reconciling the paradox of rotator cuff repair versus debridement: A unified biomechanical rationale for the treatment of rotator cuff tears. Arthroscopy 1994;10(1):4-19 20. Al-Kaisy A, McGuire G, Chan VW, Bruin G, Peng P, Miniaci A, et al. Analgesic effect of interscalene block using low-dose bupivacaine for outpatient arthroscopic shoulder surgery. Reg Anesth Pain Med 1998;23(5):469-73 21. Ilfeld BM, Vandenborne K, Duncan PW, Sessler DI, Enneking FK, Shuster JJ, et al. Ambulatory continuous interscalene nerve blocks decrease the time to discharge readiness after total shoulder arthroplasty: a randomized, triple-masked, placebo-controlled study. Anesthesiology 2006;105(5):999-1007 22. Yamakado K. Efficacy of arthroscopically placed pain catheter adjacent to the suprascapular nerve (continuous arthroscopically assisted suprascapular nerve block) following arthroscopic rotator-cuff repair. Open Access J sports Med 2014;5:129-36 23. Ganapathy S, Amendola A, Lichfield R, Fowler PJ, Ling E. Elastomeric pumps for ambulatory patient controlled regional analgesia. Can J Anaesth 2000;47(9):897-902 24. Pham TT, Bayle Iniguez X, Mansat P, Maubisson L, Bonnevialle N. Postoperative pain after arthroscopic versus open rotator cuff repair. A prospective study. Orthop Traumatol Surg Res 2016;102(1):13-7 25. Dahl JB, Rosenberg J, Dirkes WE, Mogensen T, Kehlet H. Prevention of postoperative pain by balanced analgesia. BJA 1990;64(4):518-20 26. Khalili G, Babaeizadeh A. The Preventive Effect of Intramuscular Ketamine and Methadone on Postoperative Pain after Laparoscopic Cholecystectomy. J Isfahan Med Sch 2020; 37(549): 1200-5 27.Murphy GS, Avram MJ, Greenberg SB, Benson J, Bilimoria S, Maher CE, et al. Perioperative methadone and ketamine for postoperative pain control in spinal surgical patients :a randomized, double-blind, placebo-controlled trial. Anesthesiology. 2021;134(5):697-708 28. Pacreu S, Fernández Candil J, Moltó L, Carazo J, Fernández Galinski S. The perioperative combination of methadone and ketamine reduces post‐operative opioid usage compared with methadone alone. Acta anaesthesiologica scandinavica. 2012 Nov;56(10):1250-6. 29. Park PJ, Makhni MC, Cerpa M, Lehman RA, Lenke LG. The role of perioperative ketamine in postoperative pain control following spinal surgery. Journal of Spine Surgery. 2020;6(3):591 30. Davis AM, Inturrisi CE. d-Methadone blocks morphine tolerance andN-methyl-D-aspartate-induced hyperalgesia. Journal of Pharmacology and Experimental Therapeutics. 1999 May 1;289(2):1048-53. 31. Sotgiu ML, Valente M, Storchi R, Caramenti G, Biella GE. Cooperative N-methyl-d-aspartate (NMDA) receptor antagonism and μ-opioid receptor agonism mediate the methadone inhibition of the spinal neuron pain-related hyperactivity in a rat model of neuropathic pain. Pharmacological research. 2009 Oct 1;60(4):284-90. 32. Codd EE, Shank RP, Schupsky JJ, Raffa RB. Serotonin and norepinephrine uptake inhibiting activity of centrally acting analgesics: structural determinants and role in antinociception. Journal of Pharmacology and Experimental Therapeutics. 1995 Sep 1;274(3):1263-70. 33. Ojas-Corrales MO, Berrocoso E, Gibert-Rahola J, Mico JA. Antidepressant-like effects of tramadol and other central analgesics with activity on monoamines reuptake, in helpless rats. Life sciences. 92002 Nov 29;72(2):143-52. 34. GILLIS JC, BROGDEN RN. KETOROLAC. A reappraisal of its pharmacodynamics and phar macokinetic properties and therapeutic use in pain management. Drugs 1997; 53: 139-188 35. Bernstein K, Gisselsson L, Jacobsson L, Ohrlander S. Influence of Two Different Anaesthetic Agents on the Newborn and the Correlation between Foetal Oxygenation and Induction‐Delivery Time in Elective Caesarean Section. Acta anaesthesiologica scandinavica. 1985 Feb; 29(2):157-60. 36. Ganning M, Perkins Z and Queenn T. Trench entrapment: is ketamine safe to use for sedation in head injury. Emergency medicine Journal 2007; 24: 794-5 37. Oye I, Paulsen O, Maurset A. Effects of ketamine on sensory perception: evidence for a role of N-methyl-D-aspartate receptors. Journal of Pharmacology and Experimental Therapeutics. 1992 Mar 1;260(3):1209-13. 38. Williams NR, Heifets BD, Blasey C, Sudheimer K, Pannu J, Pankow H, Hawkins J, Birnbaum J, Lyons 23, Rodriguez CI, Schatzberg AF. Attenuation of antidepressant effects of ketamine by opioid receptor antagonism. American Journal of Psychiatry. 2018 Dec 1;175(12):1205-15. 39. López-Gil X, Jiménez-Sánchez L, Campa L, Castro E, Frago C, Adell A. Role of serotonin and noradrenaline in the rapid antidepressant action of ketamine. ACS chemical neuroscience. 2019 Jun 5;10(7):3318-26. 40. Murphy GS, Szokol JW, Avram MJ, Greenberg SB, Shear TD, Deshur MA, et al. Clinical effectiveness and safety of intraoperative methadone in patients undergoing posterior spinal fusion surgery: a randomized, double-blinded, controlled trial. Anesthesiology. 2017;126:822–33. [PubMed] [Google Scholar] 41. Riddell JM, Trummel JM, Onakpoya IJ. Low-dose ketamine in painful orthopaedic surgery: a systematic review and meta-analysis. Br J Anaesth. 2019;123:325–34. [PubMed] [Google Scholar] 42. Bakhtiari E, Dori MM, Razavi MR, Yazdi AP, Yazdi AP. Comparison of low-dose ketamine to methadone for postoperative pain in opioid addicts: a randomized clinical trial. Anesthesia and Pain Medicine. 2024 Jul 7;19(3):209. 43. Riddell JM, Trummel JM, Onakpoya IJ. Low-dose ketamine in painful orthopaedic surgery: a systematic review and meta-analysis. British Journal of Anaesthesia. 2019 Sep 1;123(3):325-34. 44. Pendi A, Field R, Farhan SD, Eichler M, Bederman SS. Perioperative ketamine for analgesia in spine surgery: a meta-analysis of randomized controlled trials. Spine. 2018 Mar 1;43(5):E299-307. 45. Brinck EC, Tiippana E, Heesen M, Bell RF, Straube S, Moore RA, Kontinen V. Perioperative intravenous ketamine for acute postoperative pain in adults. Cochrane Database of Systematic Reviews. 2018(12). 46. Murphy GS, Szokol JW. Intraoperative methadone in surgical patients: a review of clinical investigations. Anesthesiology. 2019 Sep 1;131(3):678-92.

Add your comments about this article : Your username or Email:
CAPTCHA

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2024 CC BY-NC 4.0 | International Journal of Medical Investigation

Designed & Developed by : Yektaweb