Yonsei Med J.  2012 Mar;53(2):427-432. 10.3349/ymj.2012.53.2.427.

Beneficial Effects of Adding Ketamine to Intravenous Patient-Controlled Analgesia with Fentanyl after the Nuss Procedure in Pediatric Patients

• Cha MH
• Eom JH
• Lee YS
• Kim WY
• Park YC
• Min SH
• Kim JH

• KMID: 1120213
• DOI: http://doi.org/10.3349/ymj.2012.53.2.427

Abstract

PURPOSE
The aim of this prospective, double-blind, randomized study was to investigate the analgesic effects of low-dose ketamine on intravenous patient-controlled analgesia (IV-PCA) with fentanyl for pain control in pediatric patients following the Nuss procedure for pectus excavatum.
MATERIALS AND METHODS
Sixty pediatric patients undergoing the Nuss procedure were randomly assigned to receive fentanyl (Group F, n=30) or fentanyl plus ketamine (Group FK, n=30). Ten minutes before the end of surgery, following the loading dose of each solution, 0.5 microg/kg/hr of fentanyl or 0.5 microg/kg/hr of fentanyl plus 0.15 mg/kg/hr of ketamine was infused via an IV-PCA pump (basal rate, 1 mL/hr; bolus, 0.5 mL; lock out interval, 30 min). Fentanyl consumption, pain score, ketorolac use, nausea/vomiting, ondansetron use, pruritus, respiratory depression, hallucination, dreaming, and parent satisfaction with pain control were measured throughout the 48 hours following surgery.
RESULTS
The pain scores, ketorolac use, and fentanyl consumption of Group FK were significantly lower than in Group F (p<0.05). The incidence of nausea/vomiting and ondansetron use in Group FK was significantly lower than in Group F (p<0.05). There were no reports of respiratory depression, hallucination or dreaming. Parent satisfaction with pain control was similar between the two groups.
CONCLUSION
We concluded that low-dose ketamine added to IV-PCA with fentanyl after the Nuss procedure in pediatric patients can reduce pain scores, consumption of fentanyl, and incidence of nausea/vomiting without increasing side effects.

Keyword

Fentanyl; funnel chest; ketamine; patient-controlled analgesia; pediatrics

MeSH Terms

Analgesia, Patient-Controlled/*methods
Analgesics/*therapeutic use
Child
Double-Blind Method
Female
Fentanyl/*therapeutic use
Funnel Chest/surgery
Humans
Injections, Intravenous
Ketamine/*therapeutic use
Male
Pain, Postoperative/drug therapy

Figure

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  Fig. 1 Flow diagram of the progress through the trial. Group F, fentanyl group; Group FK, fentanyl plus ketamine group.

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