فهرست مطالب سید مرتضی حیدری طبایی زواره

Pain is one of the most common postoperative complications that can be reduced via different methods like combination of two or more drugs to make synergistic effect. This research aimed to comparing the preventive effect of using combination of ketamine and fentanyl or ketamine and metoclopramide on the postoperative pain after laparoscopic cholecystectomy.

In a double-blinded clinical trial study, 90 patients in class I and II of ASA (American Society of Anesthesiologists) classification who were candidates for laparoscopic cholecystectomy were divided into two groups. Half an hour before completion of the operation, patients in the first group received intravenous metoclopramide (0.1 mg/kg) and ketamine (0.5 mg/kg) slowly; while the patients in the second group received intravenous ketamine (0.5 mg/kg) and fentanyl (0.5 µg/kg) slowly. After completion of operation, the pain severity was evaluated based on the visual analogue score (VAS) and the data were compared between the two groups.

The main pain score in ketamine and metoclopramide group at the end of recovery, also at the 2nd, 6th, 12th, 24th postoperative hours, was significantly lower than ketamine and fentanyl group (P < 0.001).

Preventive administration of ketamine and metoclopramide causes more reduction in postoperative pain than ketamine and fentanyl and is not associated with any severe postoperative complication.

The postoperative pain control is performed with different methods (regional anesthesia, acupuncture, music therapy,) or drugs such as opioids, NSAIDs and Ketamine. In many researches, Metoclopramide is used for decreasing postoperative pain. The aim of this study was to compare the effect of Metoclopramide (M) and Ketamine (K) as a preemptive analgesia on postoperative pain. In a double blinded clinical trial study 86 ASA 1 and 2 patients enrolled in this study and divided into two groups of Metoclopramide (M) and Ketamine (K). Half an hour before the operation patients in group M and group K received 10 and 0.3 mg/kg, i.v. Metochlopramide and Ketamine, respectively. The pain scores and the amounts of opioid consumption in recovery room and first 24 hours and the postoperative complications such as nausea, vomiting, irritability and psychological problems were recorded. Data were analyzed using student-t test, ANOVA and Chi-square statistical analysis. There was no significant difference in demographic data including weight, age, sex, duration of surgery and basic hemodynamic parameters between two groups (P>0.05). The pain score was lower in Metoclopramide group (3.98±3.04) compared to the Ketamine group (5.93±3.32) in recovery room and first 24 hours after surgery. In addition, there was a statistical difference in the frequency of drug’s side effects in group M (30.02%) and the group K (95.3%) (P<0.001). The extubation time was significantly longer in Ketamine group (5.3±0.8) than Metoclopramide group (7.4±0.7) (P<0.05). The results of this research showed that administration of Metochlopramide before induction of anesthesia was more effective than Ketamine for reducing postoperative pain, which suggests analgesic effects of Metoclopramide.