PCA Ketamine-Morphine VS PCA Morphine as Post-Operative Analgesia in Colorectal Surgery.

Summary

The goal of this clinical trial is to compare the effectiveness of PCA ketamine-morphine versus conventional PCA morphine in postoperative patients undergoing elective laparotomy colorectal surgery under general anaesthesia. The specific objectives are: 1. To compare the postoperative analgesic requirement with PCA ketamine-morphine in comparison with PCA morphine. 2. To compare the postoperative pain scores between PCA ketamine-morphine and PCA morphine. 3. To assess patients' overall satisfaction with PCA ketamine-morphine in comparison with PCA morphine. 4. To study the incidence of side effects of PCA ketamine-morphine in comparison with PCA morphine. Participants will be screened and recruited at the pre-anaesthetic clinic (PAC). Those who consented will be taught to use the PCA machine and the potential side effects of the study drugs. They will be randomly allocated into either Group A or Group B by computer-generated randomization a day before planned surgery. Researchers will compare Group A and Group B to see post-operative pain scores, patients' overall satisfaction and any incidence of side effects.

Timeline

Start

2018-04-05

Primary completion

2019-04-04

Completion

2019-04-04

Publications

• Background Momeni M, Crucitti M, De Kock M. Patient-controlled analgesia in the management of postoperative pain. Drugs. 2006;66(18):2321-37. doi: 10.2165/00003495-200666180-00005.
• Background McNicol ED, Ferguson MC, Hudcova J. Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain. Cochrane Database Syst Rev. 2015 Jun 2;2015(6):CD003348. doi: 10.1002/14651858.CD003348.pub3.
• Background Macintyre PE. Safety and efficacy of patient-controlled analgesia. Br J Anaesth. 2001 Jul;87(1):36-46. doi: 10.1093/bja/87.1.36. No abstract available.
• Background Dolin SJ, Cashman JN. Tolerability of acute postoperative pain management: nausea, vomiting, sedation, pruritus, and urinary retention. Evidence from published data. Br J Anaesth. 2005 Nov;95(5):584-91. doi: 10.1093/bja/aei227. Epub 2005 Sep 16.
• Background Argoff CE. Recent management advances in acute postoperative pain. Pain Pract. 2014 Jun;14(5):477-87. doi: 10.1111/papr.12108. Epub 2013 Aug 15.
• Background Vadivelu N, Mitra S, Narayan D. Recent advances in postoperative pain management. Yale J Biol Med. 2010 Mar;83(1):11-25.
• Background Laskowski K, Stirling A, McKay WP, Lim HJ. A systematic review of intravenous ketamine for postoperative analgesia. Can J Anaesth. 2011 Oct;58(10):911-23. doi: 10.1007/s12630-011-9560-0. Epub 2011 Jul 20.
• Background Subramaniam K, Subramaniam B, Steinbrook RA. Ketamine as adjuvant analgesic to opioids: a quantitative and qualitative systematic review. Anesth Analg. 2004 Aug;99(2):482-95, table of contents. doi: 10.1213/01.ANE.0000118109.12855.07.
• Background Stoetling RK, Hiller SK. Pharmacology & Physiology in Anesthetic Practice. 4th edition. Philadelphia: Lippincott Williams & Wilkins. 2006.
• Background Carstensen M, Moller AM. Adding ketamine to morphine for intravenous patient-controlled analgesia for acute postoperative pain: a qualitative review of randomized trials. Br J Anaesth. 2010 Apr;104(4):401-6. doi: 10.1093/bja/aeq041. Epub 2010 Mar 5.
• Background Michelet P, Guervilly C, Helaine A, Avaro JP, Blayac D, Gaillat F, Dantin T, Thomas P, Kerbaul F. Adding ketamine to morphine for patient-controlled analgesia after thoracic surgery: influence on morphine consumption, respiratory function, and nocturnal desaturation. Br J Anaesth. 2007 Sep;99(3):396-403. doi: 10.1093/bja/aem168. Epub 2007 Jun 18.
• Background Mathews TJ, Churchhouse AM, Housden T, Dunning J. Does adding ketamine to morphine patient-controlled analgesia safely improve post-thoracotomy pain? Interact Cardiovasc Thorac Surg. 2012 Feb;14(2):194-9. doi: 10.1093/icvts/ivr081. Epub 2011 Nov 28.
• Background Kamal HM. Ketamine as an Adjuvant to Morphine for Patient Controlled Analgesia in Morbidly Obese Patients. Journal of Medical Sciences 2008; 8: 364-370.
• Background Javery KB, Ussery TW, Steger HG, Colclough GW. Comparison of morphine and morphine with ketamine for postoperative analgesia. Can J Anaesth. 1996 Mar;43(3):212-5. doi: 10.1007/BF03011736.
• Background Zakine J, Samarcq D, Lorne E, Moubarak M, Montravers P, Beloucif S, Dupont H. Postoperative ketamine administration decreases morphine consumption in major abdominal surgery: a prospective, randomized, double-blind, controlled study. Anesth Analg. 2008 Jun;106(6):1856-61. doi: 10.1213/ane.0b013e3181732776.
• Background Akhavanakbari G, Mohamadian A, Entezariasl M. Evaluation the effects of adding ketamine to morphine in intravenous patient-controlled analgesia after orthopedic surgery. Perspect Clin Res. 2014 Apr;5(2):85-7. doi: 10.4103/2229-3485.128028.
• Background Dahi-Taleghani M, Fazli B, Ghasemi M, Vosoughian M, Dabbagh A. Effect of intravenous patient controlled ketamine analgesiaon postoperative pain in opium abusers. Anesth Pain Med. 2014 Feb 15;4(1):e14129. doi: 10.5812/aapm.14129. eCollection 2014 Feb.
• Background Sveticic G, Gentilini A, Eichenberger U, Luginbuhl M, Curatolo M. Combinations of morphine with ketamine for patient-controlled analgesia: a new optimization method. Anesthesiology. 2003 May;98(5):1195-205. doi: 10.1097/00000542-200305000-00023.

Drugs

Indications

No indication recorded.