Effects of S-ketamine added to patient-controlled analgesia on early postoperative pain and recovery in patients undergoing thoracoscopic lung surgery : A randomized double-blinded controlled trial
Copyright © 2023 Elsevier Inc. All rights reserved..
STUDY OBJECTIVE: To investigate whether the addition of S-ketamine to patient-controlled hydromorphone analgesia decreases postoperative moderate-to-severe pain and improves the quality of recovery (QoR) in patients undergoing thoracoscopic lung surgery.
DESIGN: Single-center prospective randomized double-blinded controlled trial.
SETTING: Tertiary university hospital.
PATIENTS: 242 patients undergoing thoracoscopic lung surgery.
INTERVENTIONS: Patients were randomized to receive intravenous patient-controlled analgesia (IV-PCA) with hydromorphone alone or hydromorphone combined with S-ketamine (0.5 mg/kg/48 h, 1 mg/kg/48 h, or 2 mg/kg/48 h).
MEASUREMENTS: Primary outcome was proportion of patients with moderate-to-severe pain. (numerical rating scale [NRS] pain scores ≥4 when coughing) within 2 days after surgery. Postoperative QoR scores and other prespecified outcomes were also recorded.
MAIN RESULTS: Of 242 enrolled patients, 220 were included in the final analysis. The results demonstrated that the incidence of postoperative moderate-to-severe pain was significantly different between the hydromorphone group and combined S-ketamine group (absolute difference, 27.9%; 95% confidence interval [CI], 11.7% to 42.1%; P < 0.001). Patients who received S-ketamine had lower NRS pain scores at rest and when coughing on postoperative day 1 (POD1; median difference 1 and 1, P < 0.001) and postoperative day 2 (POD2; median difference 1 and 1, P < 0.001). The QoR-15 scores were higher in the combined S-ketamine group on POD1 (mean difference 6, P < 0.001) and POD2 (mean difference 6, P < 0.001) than in the hydromorphone group. A higher dose of S-ketamine was associated with deeper sedation. No differences were detected in the other safety outcomes.
CONCLUSIONS: Addition of S-ketamine to IV-PCA hydromorphone significantly reduced the incidence of postoperative moderate-to-severe pain and improved the QoR in patients undergoing thoracoscopic lung surgery.
TRIAL REGISTRATION: Chinese Clinical Trail Register (identifier: ChiCTR2200058890).
| Errataetall: |
CommentIn: J Clin Anesth. 2024 Jun;94:111421. - PMID 38402688 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:92 |
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| Enthalten in: |
Journal of clinical anesthesia - 92(2024) vom: 01. Feb., Seite 111299 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Zhang, Anyu [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 27.11.2023 Date Revised 12.03.2024 published: Print-Electronic CommentIn: J Clin Anesth. 2024 Jun;94:111421. - PMID 38402688 Citation Status MEDLINE |
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| doi: |
10.1016/j.jclinane.2023.111299 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM364313501 |
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| 100 | 1 | |a Zhang, Anyu |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Effects of S-ketamine added to patient-controlled analgesia on early postoperative pain and recovery in patients undergoing thoracoscopic lung surgery |b A randomized double-blinded controlled trial |
| 264 | 1 | |c 2024 | |
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| 500 | |a Date Completed 27.11.2023 | ||
| 500 | |a Date Revised 12.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: J Clin Anesth. 2024 Jun;94:111421. - PMID 38402688 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 Elsevier Inc. All rights reserved. | ||
| 520 | |a STUDY OBJECTIVE: To investigate whether the addition of S-ketamine to patient-controlled hydromorphone analgesia decreases postoperative moderate-to-severe pain and improves the quality of recovery (QoR) in patients undergoing thoracoscopic lung surgery | ||
| 520 | |a DESIGN: Single-center prospective randomized double-blinded controlled trial | ||
| 520 | |a SETTING: Tertiary university hospital | ||
| 520 | |a PATIENTS: 242 patients undergoing thoracoscopic lung surgery | ||
| 520 | |a INTERVENTIONS: Patients were randomized to receive intravenous patient-controlled analgesia (IV-PCA) with hydromorphone alone or hydromorphone combined with S-ketamine (0.5 mg/kg/48 h, 1 mg/kg/48 h, or 2 mg/kg/48 h) | ||
| 520 | |a MEASUREMENTS: Primary outcome was proportion of patients with moderate-to-severe pain. (numerical rating scale [NRS] pain scores ≥4 when coughing) within 2 days after surgery. Postoperative QoR scores and other prespecified outcomes were also recorded | ||
| 520 | |a MAIN RESULTS: Of 242 enrolled patients, 220 were included in the final analysis. The results demonstrated that the incidence of postoperative moderate-to-severe pain was significantly different between the hydromorphone group and combined S-ketamine group (absolute difference, 27.9%; 95% confidence interval [CI], 11.7% to 42.1%; P < 0.001). Patients who received S-ketamine had lower NRS pain scores at rest and when coughing on postoperative day 1 (POD1; median difference 1 and 1, P < 0.001) and postoperative day 2 (POD2; median difference 1 and 1, P < 0.001). The QoR-15 scores were higher in the combined S-ketamine group on POD1 (mean difference 6, P < 0.001) and POD2 (mean difference 6, P < 0.001) than in the hydromorphone group. A higher dose of S-ketamine was associated with deeper sedation. No differences were detected in the other safety outcomes | ||
| 520 | |a CONCLUSIONS: Addition of S-ketamine to IV-PCA hydromorphone significantly reduced the incidence of postoperative moderate-to-severe pain and improved the QoR in patients undergoing thoracoscopic lung surgery | ||
| 520 | |a TRIAL REGISTRATION: Chinese Clinical Trail Register (identifier: ChiCTR2200058890) | ||
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Anesthesia | |
| 650 | 4 | |a Pain | |
| 650 | 4 | |a Patient-controlled analgesia | |
| 650 | 4 | |a Quality of recovery | |
| 650 | 4 | |a S-ketamine | |
| 650 | 4 | |a Thoracoscopic lung surgery | |
| 650 | 7 | |a Analgesics, Opioid |2 NLM | |
| 650 | 7 | |a Esketamine |2 NLM | |
| 650 | 7 | |a 50LFG02TXD |2 NLM | |
| 650 | 7 | |a Hydromorphone |2 NLM | |
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| 700 | 1 | |a Zhou, Yongxin |e verfasserin |4 aut | |
| 700 | 1 | |a Zheng, Xi |e verfasserin |4 aut | |
| 700 | 1 | |a Zhou, Weichao |e verfasserin |4 aut | |
| 700 | 1 | |a Gu, Yu |e verfasserin |4 aut | |
| 700 | 1 | |a Jiang, Zeyong |e verfasserin |4 aut | |
| 700 | 1 | |a Yao, Yonghua |e verfasserin |4 aut | |
| 700 | 1 | |a Wei, Wei |e verfasserin |4 aut | |
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