Intra-articular Ketamine for Pain Control Following Arthroscopic Knee Surgery

背景：本實驗是為了要證明ketamine於關節腔內滑液囊上之周邊止痛作用，以及為了改善關節鏡術的疼痛程度。方法：於關節鏡手術術後將kctamine注射至關節腔中，并以變盲，隨機取樣的方式，選取60位病人，分為3組，全部實施半身脊髓麻醉。A組的病人，於關節鏡手術縫完表皮之後，將5毫升等張食監水溶液注射至關節腔中，B組的病人於術後，在臀大肌注射每公斤體重0.5毫克的ketamine。C組的病人，於關節鏡術後，用每公斤體重0.5毫克的Kctamine 以等張的食監水溶劑稀釋至5毫升，并注射至關節腔中。手術結束之後，在不同的時段追蹤24小時，并以visual analogue scalc(VAS 0 to 10)比較三組病人的患側於伸直休息及主動變曲60度時的疼痛程度。術後則依據病人關節疼痛的程度以及需求，給予每公斤1毫克的 pethidine，并記錄給藥的時間及總量。結果：實驗結果顯示，三組的病人於伸直休息及主動變曲60度時的疼痛程度并無明顯的差异性。且於術後Pethidine之使用量上亦無明顯的差別。結論：根據前人在動物及人體的研究指出，ketamine有周邊止痛的作用，而作用時間并不確定。但是本實驗的結果顯示，ketamine於關節腔內的周邊止痛作用并不明顯，因此ketamine於關節鏡術後的疼痛控制，似乎不太具有臨床意義。

關鍵字

Ketamine ； NMDA受體；關節鏡

並列摘要

Background: In an attempt to demonstrate the peripheral effect of ketamine on the synovia of knee joint and to smoothen the recovery from arthroscopic knee surgery, this study was designed to evaluate the analgesic effect of intra-articular ketamine injection after knee arthroscopy. Methods: In a double blind randomized study, 60 patients were assigned to three groups. Group A patients received saline 5 mL intra-articularly after closure of the surgical wound to serve as control; group B patients received ketamine 0.5 mg/kg of body weight intra-muscularly to rule out the systemic effect and group C patients received ketamine 0.5 mg/kg of body weight diluted with saline up to 5 mL intra-articularly. After surgery, patients were evaluated for pain with visual analogue scale (VAS 0 to 10) for 24 h with the operated leg in the position of extension rest and active flexion of the knee joint to 60 degree angle. Rescue pethidine (1 mg/kg of body weight) was given intra-muscularly for pain relief at request every 4 h postoperatively if necessary. The time to first rescue analgesic request was recorded, and the total doses of pethidine were calculated. Results: The results showed no difference in the VAS pain scores at rest and during active motion in the range of 60 degree among three groups during a 24 h observation. Conclusions: Ketamine had been reported to have peripheral analgesic effects with variable duration on measurements of pain and hyperalgesia. Howevet; in the present study, we failed to demonstrate that ketamine could provide a clinically relevant peripheral analgesic effect for postoperative arthroscopic pain.

並列關鍵字

Ketamine ； Receptors: N-methyl-D-aspartate (NMDA) ； Anthroscopy ； Peripheral.

國際替代計量

Intra-articular Ketamine for Pain Control Following Arthroscopic Knee Surgery

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